P3687 - AIH Cirrhosis vs Other Etiologies: A Trade-Off Between Survival and Severity

Chidera Onwuzo, MBBS¹, Somtochukwu Onwuzo, MD², Rashid Abdel-Razeq, MD³, Antoine Boustany, MD⁴, Kojo-Frimpong B. Awuah, MD⁵, Prerna Ashok Kherajani, MBBS⁶, Ojiugo Moka, MBBS⁷, Shefali Mody, MBBS¹, Avneet Kaur, MBBS¹, Alvina, MD¹, Laith Alomari, MD⁸, Vishal Busa, MD¹
1SUNY Upstate Medical University Hospital, Syracuse, NY; 2Allegheny Center for Digestive Health, Pittsburgh, PA; 3Cleveland Clinic Foundation, Cleveland, OH; 4University of Florida College of Medicine, Jacksonville, FL; 5Allegheny Health Network, Pittsburgh, PA; 6SUNY Upstate Medical University, Syracuse, NY; 7Benjamin S. Carson (SNR) College of Health and Medical Sciences, Ilishan, Ogun, Nigeria; 8Thomas Jefferson University, Philadelphia, PA

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 two 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.

Discussion: 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.


Figure: Figure 1: Baseline characteristics table of study population and Graph showing change in standard difference before and after matching


Figure: Figure 2: Chart showing comparative outcomes and Forest plot depicting odds ratio of outcomes.

Disclosures:
Chidera Onwuzo indicated no relevant financial relationships.
Somtochukwu Onwuzo indicated no relevant financial relationships.
Rashid Abdel-Razeq indicated no relevant financial relationships.
Antoine Boustany indicated no relevant financial relationships.
Kojo-Frimpong B. Awuah indicated no relevant financial relationships.
Prerna Ashok Kherajani indicated no relevant financial relationships.
Ojiugo Moka indicated no relevant financial relationships.
Shefali Mody indicated no relevant financial relationships.
Avneet Kaur indicated no relevant financial relationships.
Alvina indicated no relevant financial relationships.
Laith Alomari indicated no relevant financial relationships.
Vishal Busa indicated no relevant financial relationships.

Chidera Onwuzo, MBBS¹, Somtochukwu Onwuzo, MD², Rashid Abdel-Razeq, MD³, Antoine Boustany, MD⁴, Kojo-Frimpong B. Awuah, MD⁵, Prerna Ashok Kherajani, MBBS⁶, Ojiugo Moka, MBBS⁷, Shefali Mody, MBBS¹, Avneet Kaur, MBBS¹, Alvina, MD¹, Laith Alomari, MD⁸, Vishal Busa, MD¹. P3687 - AIH Cirrhosis vs Other Etiologies: A Trade-Off Between Survival and Severity, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.