Older Age and Disease Duration Are Highly Associated with Hepatocellular Carcinoma in Patients with Autoimmune Hepatitis

  • Lara Dakhoul
  • Keaton R. Jones
  • Samer Gawrieh
  • Marwan Ghabril
  • Chelsey McShane
  • Raj Vuppalanchi
  • Eduardo Vilar-Gomez
  • Lauren Nephew
  • Naga ChalasaniEmail author
  • Craig LammertEmail author
Original Article



Hepatocellular carcinoma (HCC) is rare in patients with autoimmune hepatitis (AIH). However, the overall burden of AIH cirrhosis in causing HCC and patients’ risk factors are not well understood.


To characterize the proportion of HCC linked to AIH at a large academic health center, and to identify variables associated with HCC in patients with AIH in a case–control study design.


Over a 14.5-year period, medical records of all patients with HCC were reviewed. Cases are AIH patients identified from the cohort, and controls are patients with AIH without HCC. Three controls were randomly chosen from the Genetic Repository of Autoimmune Liver Disease and Coexisting Exposures database for each eligible case.


Out of 1250 eligible patients, 20 were linked to AIH (1.6%). Their median age was 64 years, 40% men and 100% Caucasian. Ten percent of AIH patients did not have evidence of cirrhosis at HCC diagnosis. The proportion of HCCs due to AIH decreased during the time intervals of the study. Compared to controls, cases were more likely men (40.0% vs. 18%, p = 0.049), with longer AIH duration (median 16 years vs. 5 years, p = 0.004). Prolonged AIH duration (OR 1.68, p = 0.006) and older age (OR 1.15, p = 0.049) were risk factors for HCC.


AIH is a rare cause (1.6%) for HCC in Midwestern USA with a decreasing trend over 14.5 years. Ten percent of AIH-HCC patients did not have cirrhosis at time of HCC diagnosis. Patients with prolonged duration of the disease and older age are at high risk to develop HCC.


Liver cancer Autoimmune liver disease Older age Disease duration 



Autoimmune hepatitis


Hepatocellular carcinoma


Genetic Repository of Autoimmune Liver Disease and Coexisting Exposures


Antinuclear antibodies


Anti-smooth muscle antibodies


Standard deviation


Interquartile range


Nonalcoholic fatty liver disease


Body mass index


Model for End-Stage Liver Disease


Ursodeoxycholic acid


AST-to-platelet ratio index




Barcelona Clinic Liver Cancer


Compliance with ethical standards

Conflict of interest

Authors declare no conflicts of interest relevant for this paper.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Lara Dakhoul
    • 1
  • Keaton R. Jones
    • 1
  • Samer Gawrieh
    • 1
  • Marwan Ghabril
    • 1
  • Chelsey McShane
    • 2
  • Raj Vuppalanchi
    • 1
  • Eduardo Vilar-Gomez
    • 1
  • Lauren Nephew
    • 1
  • Naga Chalasani
    • 1
    Email author
  • Craig Lammert
    • 1
    Email author
  1. 1.Division of Gastroenterology and HepatologyIndiana University School of MedicineIndianapolisUSA
  2. 2.Department of Internal MedicineIndiana University School of MedicineIndianapolisUSA

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