{
  "abstract": "The first line treatment for autoimmune hepatitis with Azathioprine and prednisolone is effective in 80–90% children. Tacrolimus is used as second or third-line agent in children with 75%- 94% attaining biochemical remission.This is a retrospective audit on the use of tacrolimus in autoimmune hepatitis in children ≤16 years from 2010- 2024. Demographics, indications of tacrolimus use, clinical course, laboratory parameters, liver biopsies (fibrosis staged by Ishak fibrosis score), treatment response, complications and outcomes of therapy (remission, relapse or liver transplantation) were assessed. Biochemical remission was defined as alanine aminotransferase <40 IU/ml.Tacrolimus was used as second (n=7) or third (n=4) immunosuppressant in 11 children over a time period of 14 years. Tacrolimus was started at a median age of 14.5 (IQR 13- 16) years and interval between diagnosis of autoimmune hepatitis and initiation of tacrolimus was 14 (9 -60) months. The indications for changing to tacrolimus were failure of first line therapy (n=10), complications related to previous immune suppressive therapy (n=5) and non-compliance with previous therapy (n=2). Progression of fibrosis stage was noted in 72% (n=8) at the time of initiation of tacrolimus as compared to the liver biopsy at diagnosis. Initial biochemical remission was attained in 55% (n=6) and only 27% (n=3) attained long term remission with tacrolimus therapy. The total duration of follow-up on tacrolimus was 17 (IQR 11- 32) months. Five children (45%) were listed for liver transplantation while three children were started on additional biological therapy. There were no complications from the use of tacrolimus during the study period.Tacrolimus might be useful as an alternative immunosuppressive drug in a very select group of children with treatment failure, incomplete response, or intolerance to first-line agents. Careful selection of patients is necessary as those with advanced liver disease with initial treatment failure is unlikely to respond, with progression of disease over time necessitating addition of biologics or need for liver transplantation.",
  "authors": [
    {
      "affiliations": [
        "Birmingham Women’s and Children’s NHS Foundation trust"
      ],
      "name": "Amira Ali"
    },
    {
      "affiliations": [
        "Birmingham Women’s and Children’s NHS Foundation trust"
      ],
      "name": "Jane Hartley"
    },
    {
      "affiliations": [
        "Birmingham Women’s and Children’s NHS Foundation trust"
      ],
      "name": "Lauren Johansen"
    },
    {
      "affiliations": [
        "Birmingham Women’s and Children’s NHS Foundation trust"
      ],
      "name": "Girish Gupte"
    },
    {
      "affiliations": [
        "Birmingham Women’s and Children’s NHS Foundation trust"
      ],
      "name": "Joseph Valamparampil"
    }
  ],
  "title": "OC49 Tacrolimus in children with autoimmune hepatitis",
  "uid": "b97cf01a-0762-5288-9603-04d19651ae48"
}