Liver and Bile

J Hepatol. 2024;80(1):53–61

Colapietro F, Maisonneuve P, Lytvyak E, Beuers U, Verdonk RC, van der Meer AJ, van Hoek B, Kuiken SD, Brouwer JT, Muratori P, Aghemo A, Carella F, van den Berg AP, Zachou K, Dalekos GN, Di Zeo-Sánchez DE, Robles M, Andrade RJ, Montano-Loza AJ, van den Brand FF, Slooter CD, Macedo G, Liberal R, de Boer YS, Lleo A; Dutch AIH Study Group; International Autoimmune Hepatitis Group

Incidence and predictors of hepatocellular carcinoma in patients with autoimmune hepatitis

Background and aims: Autoimmune hepatitis (AIH) is a rare chronic liver disease of unknown etiology; the risk of hepatocellular carcinoma (HCC) remains unclear and risk factors are not well-defined. The authors aimed to investigate the risk of HCC across a multicenter AIH cohort and to identify predictive factors.
Methods: They performed a retrospective, observational, multicentric study of patients included in the International Autoimmune Hepatitis Group Retrospective Registry. The assessed clinical outcomes were HCC development, liver transplantation, and death. Fine and Gray regression analysis stratified by center was applied to determine the effects of individual covariates; the cumulative incidence of HCC was estimated using the competing risk method with death as a competing risk.
Results: A total of 1428 patients diagnosed with AIH from 1980 to 2020 from 22 eligible centers across Europe and Canada were included, with a median follow-up of 11.1 years (interquartile range, 5.2–15.9). 293 patients (20.5%) had cirrhosis at diagnosis. During follow-up, 24 patients developed HCC (1.7%), an incidence rate of 1.44 cases/1000 patient-years; the cumulative incidence of HCC increased over time (0.6% at 5 years, 0.9% at 10 years, 2.7% at 20 years, and 6.6% at 30 years of follow-up). Patients who developed cirrhosis during follow-up had a significantly higher incidence of HCC. The cumulative incidence of HCC was 2.6%, 4.6%, 5.6% and 6.6% at 5, 10, 15, and 20 years after the development of cirrhosis, respectively. Obesity (hazard ratio [HR] = 2.94, p = 0.04), cirrhosis (HR = 3.17, p = 0.01), and AIH/primary sclerosing cholangitis variant syndrome (HR = 5.18, p = 0.007) at baseline were independent risk factors for HCC development.

Conclusions: Incidence of hepatocellular carcinoma in autoimmune hepatitis (AIH) is low even after cirrhosis development and is associated with risk factors including obesity, cirrhosis, and AIH-PSC variant syndrome.

Prof. Dr. A. Lleo, Division of Internal Medicine and Hepatology, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Rozzano, Italy, E-Mail: ana.lleo@humanitas.it

DOI: 10.1016/j.jhep.2023.09.010

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Liver and Bile

Adequate versus deep response to ursodeoxycholic acid in primary biliary cholangitis: To what extent and under what conditions is normal alkaline phosphatase level associated with complication-free survival gain?

Hepatology. 2024;79(1):39–48

Corpechot C, Lemoinne S, Soret PA, Hansen B, Hirschfield G, Gulamhusein A, Montano-Loza AJ, Lytvyak E, Pares A, Olivas I, Eaton JE, Osman KT, Schramm C, Sebode M, Lohse AW, Dalekos G, Gatselis N, Nevens F, Cazzagon N, Zago A, Russo FP, Floreani A, Abbas N, Trivedi P, Thorburn D, Saffioti F, Barkai L, Roccarina D, Calvaruso V, Fichera A, Delamarre A, Sobenko N, Villamil AM, Medina-Morales E, Bonder A, Patwardhan V, Rigamonti C, Carbone M, Invernizzi P, Cristoferi L, van der Meer A, de Veer R, Zigmond E, Yehezkel E, Kremer AE, Deibel A, Bruns T, Große K, Wetten A, Dyson JK, Jones D, Dumortier J, Pageaux GP, de Lédinghen V, Chazouillères O, Carrat F; Global & ERN Rare-Liver PBC Study Groups

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Liver and Bile

Lack of complete biochemical response in autoimmune hepatitis leads to adverse outcome: First report of the IAIHG retrospective registry

Hepatology. 2024;79(3):538–50