Background and aims: Wilson disease (WD) is an inherited disorder of copper metabolism. When treated, the outcome can be excellent, although the long‐term survival has yet to be well documented. The aim of this study was to describe the long‐term outcome of a cohort of patients with WD and to assess those factors affecting the phenotypic manifestation of WD.

Methods: The presence of mutations to the ATP7B gene, the clinical manifestations, treatments and the long‐term outcomes were analysed retrospectively in 117 patients with WD (59 men and 58 women, aged at evaluation 38.5 ± 11, range 16–63 years).

Results: Fifty‐five patients with a neurological presentation, 51 patients with a hepatic presentation and 11 asymptomatic patients were followed up for an average of 15.1 ± 10 years (median 12 years, range 1–41 years). The H1069Q ATP7B gene mutation was the most frequent genetic variant (54.3%); the frequency of this mutation did not differ between patients with either the hepatic or the neurological presentation (P=0.099). d‐penicillamine or zinc salts (81 and 17% respectively) were used for treatment, and three patients underwent liver transplantation. The majority of symptomatic patients became asymptomatic, or improved, during the follow‐up (82% patients with hepatic presentation, 69% with neurological presentation). The long‐term survival of patients with WD did not differ from that of the general Czech population (P=0.95).

Conclusions: Long‐term follow‐up shows a satisfactory response in the great majority of adequately treated patients with WD and survival coincides with that of the general population.