Insights Into Hepatic Sarcoidosis: Analysis of Histological Patterns, Hepatic Complications and Therapeutic Approaches.

Background And Aims: Sarcoidosis is a granulomatous multi-systemic disorder of uncertain aetiology frequently involving the liver. This study aimed to delineate the histological characteristics, treatment effectiveness and factors predictive of liver-related complications in individuals with hepatic sarcoidosis.

Methods: This retrospective cohort study included patients diagnosed with hepatic sarcoidosis by liver biopsy, which was conducted at two tertiary care centres from January 2009 to December 2023. We analysed demographic, clinical and laboratory parameters, treatment response and outcome.

Results: We enrolled 70 hepatic sarcoidosis patients with a median follow-up of 45 months (IQR 11-97 months), including 37 males with a median age of 48 years (IQR 37-59 years). Elevated GGT (94%) and ALP (81%) were the most common liver-specific biochemical alterations observed. Using mini-laparoscopy for liver biopsy made it possible to macroscopically identify granulomatous disease in 71% of patients. While at baseline, 16% of the cohort showed evidence of potential portal hypertension, at the last follow-up, 23% of patients developed complications related to portal hypertension. In addition to granulomatous changes, bile duct irregularities were found in 57% of liver biopsies, indicating cholangiopathy being part of the hepatic manifestation of sarcoidosis. Treatment with Ursodeoxycholic acid and prednisolone resulted in a significantly more pronounced decrease in ALT and ALP compared to untreated patients.

Conclusions: Patients with hepatic sarcoidosis require careful assessment of disease manifestation with a particular focus on portal hypertension. Treatment with UDCA and prednisolone leads to a reduction of biochemical parameters in a significant proportion of these patients.