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The Impact of Metabolic Dysfunction-Associated Steatotic Liver Disease on Autoimmune Hepatitis Outcomes: A Nationwide

Yassine Kilani1, Mohammad Aldiabat2, Kym Yves T Sirilan3

  • 1Division of General Internal Medicine, Department of Medicine, Saint Louis University School of Medicine, St. Louis, Missouri, USA.

Clinical and Translational Gastroenterology
|September 12, 2025
PubMed
Abstract

Insights

Metabolic dysfunction-associated steatotic liver disease (MASLD) worsens outcomes for patients with autoimmune hepatitis (AIH). This large-scale study found MASLD increased cirrhosis and cancer risks, despite reducing short-term mortality and immunosuppression needs.

Area of Science:

  • Hepatology
  • Gastroenterology
  • Clinical Research

Background:

  • The overlap between autoimmune hepatitis (AIH) and metabolic dysfunction-associated steatotic liver disease (MASLD) is increasingly recognized.
  • Existing studies on AIH-MASLD overlap are limited by small sample sizes, necessitating large-scale investigations.

Purpose of the Study:

  • To investigate the impact of MASLD on the clinical outcomes of patients diagnosed with AIH.
  • To utilize large-scale, real-world data to analyze outcomes in AIH patients with and without MASLD.

Main Methods:

  • A cohort study was conducted using the TriNetX research network, identifying US adults (≥18 years) with AIH.
  • Patients were stratified into AIH with MASLD (AIH-MASLD) and AIH without MASLD (controls).
  • Propensity score matching (1:1) was employed to balance demographic, comorbidity, and treatment variables between cohorts. Outcomes were assessed at short-term (1 year) and long-term (10 years) intervals.

Main Results:

  • 1,440 AIH-MASLD patients were matched with 1,440 controls from 4,798 AIH records.
  • AIH-MASLD patients showed a reduced 1-year risk of all-cause mortality (HR 0.66) and immunosuppressive medication use (HR 0.69).
  • Conversely, AIH-MASLD patients had increased 10-year risks of cirrhosis (HR 1.22) and hepatocellular carcinoma (HR 2.03) compared to controls.

Conclusions:

  • Real-world evidence indicates a significant association between MASLD and adverse clinical outcomes in AIH patients.
  • The presence of MASLD in AIH patients is linked to higher long-term risks of cirrhosis and hepatocellular carcinoma.
  • Early detection and management of MASLD in AIH patients are crucial for improving long-term prognosis.
Keywords:
autoimmune hepatitismetabolic dysfunction-associated steatotic liver diseasemetabolic syndrome

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