P-9 AUTOIMMUNE LIVER DISEASES IN LATIN AMERICA: A WEB-BASED SURVEY

Introduction and Objectives

Autoimmune liver diseases (AILD), including autoimmune hepatitis (AIH), primary biliary cholangitis (PBC), and primary sclerosing cholangitis (PSC), are chronic immune-mediated liver conditions. This study aimed to assess the reality of AILD in Latin America (LA).

Materials and Methods

A web-based survey consisting of 35 questions on AILD was distributed to hepatologists affiliated with ALEH through social media.

Results

A total of 65 hepatologists participated in the survey. The most treated AILD in the region was AIH. Widely available antibodies for diagnosis included anti-mitochondrial (100%), anti-smooth muscle (98.5%), and anti-nuclear antibodies (95.4%), while access to anti-gp210/sp100 antibodies was limited (<55%). Although 97% had access to liver biopsy, only 72.3% were assisted by liver pathologists. Elastography and endoscopic retrograde cholangiopancreatography were available for 90.8% and 98.5%, respectively. Ursodeoxycholic acid (UDCA) was the primary medication for PBC (100%), followed by fibrates (bezafibrate: 56.3%, fenofibrate: 71.9%). There was considerable heterogeneity in selecting the criteria to evaluate PBC response to UDCA, with 39.3% favoring Paris II criteria. Cholestyramine/antihistamines were commonly recommended for treating pruritus, while fibrates were used by only 47.7%. For PSC, 86.2% of hepatologists indicated the use of UDCA. Azathioprine was the main immunosuppressor employed for AIH treatment, although indications for treatment were controversial. Most physicians treated patients with signs of active disease, regardless of liver enzyme and IgG levels. Prednisone alone was the primary treatment recommended for AIH patients with decompensated cirrhosis (70.7%). Remission in AIH was mostly defined by normalization of liver enzymes and IgG with minimal/absent inflammation on histology (47.7%), with only 60% of respondents performing liver biopsies to assess histological remission. While 62.5% of the participants attempted to withdraw AIH treatment, 78% refrained from discontinuing treatment in the presence of anti-SLA.

Conclusions

This survey provides valuable insights into the current management of AILD in LA, highlighting areas of heterogeneity that warrant further investigation.