Hepatic Sarcoidosis: Clinical Characteristics and Outcome

Background Clinical manifestation of hepatic involvement in sarcoidosis can vary from asymptomatic disease to severe complications such as liver cirrhosis and portal hypertension. However, data on hepatic sarcoidosis are limited and evidence-based recommendations are lacking. Our study aimed to assess the features and clinical course of hepatic sarcoidosis in a predominantly Caucasian cohort.

Methods We performed a retrospective study including all patients with hepatic sarcoidosis between 2004 and 2020 in 5 German centers. The median follow-up time was 36 months (range 0.0, 195). Data on demographic parameters, clinical manifestations, treatment and outcome were collected.

Results A total of 1476 patients with sarcoidosis and 62 patients with hepatic involvement (4.2%) were identified. 51.6% were female and 80.6% Caucasian. Most patients were asymptomatic and were observed to have a cholestatic pattern of liver enzyme elevations. Liver cirrhosis was detected in 9 patients (14.5%), of whom 6 developed clinical manifestations of portal hypertension. 54 patients were medically treated, most commonly with glucocorticoids (69.4%) or ursodeoxycholic acid (UDCA) (40.3%). Levels of ALP decreased 60.8% on average from baseline in patients treated with glucocorticoids and 59.9% in patients treated with UDCA. None of the patients underwent liver transplantation or developed hepatocellular carcinoma (HCC). Three of the patients died during follow-up due to liver-related complications.

Conclusions Hepatic involvement in sarcoidosis was found in 4.2% of patients and was clinically significant in 14.5% of those. These findings highlight the importance of early identifying and monitoring hepatic sarcoidosis, given its increased mortality when associated with end-stage liver disease.