S2601 AIH Cirrhosis vs Other Etiologies: A Trade-Off Between Survival and Severity

Introduction: Autoimmune hepatitis (AIH) is a chronic inflammatory liver disease characterized by immune-mediated hepatocyte injury and progression to fibrosis and cirrhosis if untreated. While the pathogenesis and treatment of AIH are well studied, its long-term impact when it progresses to cirrhosis remains underexplored, particularly in comparison to cirrhosis from other etiologies. This study aimed to define the clinical profile of AIH-related cirrhosis by comparing hepatic and mortality outcomes to non-AIH cirrhosis. Methods: We used the TriNetX Global Collaborative Network to perform a retrospective cohort study of adults with cirrhosis, comparing those with (n = 19,212) and without AIH (n = 730,975). Propensity score matching (1:1) balanced demographics and comorbidities, resulting in 2 matched cohorts of 19,211 patients. Outcomes included mortality, hepatocellular carcinoma (HCC), portal vein thrombosis (PVT), liver transplantation, varices, ascites, spontaneous bacterial peritonitis (SBP), hepatic encephalopathy (HE), and hepatorenal syndrome (HRS). Odds ratios (OR) with 95% confidence intervals (CI) were used for comparison. Results: Patients with AIH-related cirrhosis had significantly lower odds of mortality (OR 0.915, 95% CI 0.872–0.959, P < 0.001) and HCC (OR 0.545, 95% CI 0.401–0.739, P < 0.001) compared to those with cirrhosis from other causes. However, AIH-cirrhosis was associated with significantly increased odds of PVT (OR 1.634, 95% CI 1.483–1.801), liver transplantation (OR 2.503, 95% CI 2.222–2.820), varices (OR 1.391, 95% CI 1.316–1.471), ascites (OR 1.176, 95% CI 1.111–1.244), SBP (OR 1.305, 95% CI 1.178–1.445), HE (OR 1.172, 95% CI 1.089–1.261), and HRS (OR 1.255, 95% CI 1.138–1.383)—all P < 0.001. Conclusion: Our study suggests that cirrhosis due to autoimmune hepatitis presents a paradoxical clinical profile: patients may experience lower short-term mortality and reduced hepatocellular carcinoma risk, yet are more likely to develop complications such as portal hypertension, infections, and require liver transplantation. While AIH-related cirrhosis may appear less fatal in the near term, its trajectory seems marked by a higher burden of clinically significant decompensation. These findings highlight the need for proactive monitoring, individualized care, and further research to guide long-term management.