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. 2025 Apr 16;15(1):13212.
doi: 10.1038/s41598-025-96342-7.

Risk of hepatocellular carcinoma and cirrhosis decompensation in a large retrospective cohort of cirrhotic patients with autoimmune hepatitis

Mifleh Tatour  1   2 , Eli Zuckerman  3   4 , Naim Abu-Freha  5   6 , Rawi Hazzan  7   8
Affiliations

Risk of hepatocellular carcinoma and cirrhosis decompensation in a large retrospective cohort of cirrhotic patients with autoimmune hepatitis

Mifleh Tatour et al. Sci Rep. .

Abstract

Autoimmune hepatitis (AIH) is a chronic inflammatory liver disease that can lead to cirrhosis in up to 30% of patients. Cirrhotic patients are at risk of high morbidity and mortality due to cirrhosis decompensation and hepatocellular carcinoma (HCC). This retrospective study assessed the rates of decompensated cirrhosis and HCC in patients with AIH-related cirrhosis. A total of 774 AIH patients were included, with 40% developing cirrhosis. Over a median follow-up of 8.2 years (IQR 2.9-12.3), the annual incidence of decompensated cirrhosis was 4.25%, with a mean time of 8.2 years from cirrhosis diagnosis to decompensation. Nineteen cirrhotic patients (6.2%) developed HCC, with a yearly incidence rate of 0.63%. Most HCC cases occurred within the first years of cirrhosis diagnosis. The rate of decompensated cirrhosis in AIH patients was lower than in other cirrhotic liver diseases, suggesting AIH may follow a different clinical course. The annual incidence of HCC was also significantly lower than the threshold for HCC surveillance. This indicates the need to reassess current surveillance guidelines, particularly in the late years following a cirrhosis diagnosis.

Keywords: Autoimmune hepatitis; Cirrhosis; Cirrhosis decompensation hepatocellular carcinoma.

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Conflict of interest statement

Declarations. Competing interests: The authors declare no competing interests. Informed consent: Informed consent was waived by the Institutional Review Board (IRB) of Clalit Health Services and Emek Medical Center (approval number 0091-23).

Figures

Fig. 1
Fig. 1
Overall survival of patients with AIH. Overall survival after AIH diagnosis was plotted using the Kaplan–Meier method.
Fig. 2
Fig. 2
Development of DC after diagnosis of cirrhosis in patients with AIH. The cumulative incidence of decompensated cirrhosis after the diagnosis of cirrhosis was estimated using the cumulative incidence function. AIH, autoimmune hepatitis; DC, decompensated cirrhosis.
Fig. 3
Fig. 3
Development of HCC after diagnosis of cirrhosis in patients with AIH. The cumulative incidence of HCC after the diagnosis of cirrhosis was estimated using the cumulative incidence function. AIH, autoimmune hepatitis; HCC, hepatocellular carcinoma.
Fig. 4
Fig. 4
Development of liver transplantation after diagnosis of cirrhosis in patients with AIH. The cumulative incidence of liver transplantation after the diagnosis of cirrhosis was estimated using the cumulative incidence function. AIH, autoimmune hepatitis.
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