Recurring intrahepatic cholestasis of pregnancy presents with distinct changes in the gut microbiota

splenomegaly reported in 116 patients (9.6 %).PBC and PSC overlap syndromes were observed in 9.7 % and 7.5 % of the cohort.Treatment at baseline included the use of prednisone in 83.5 % of patients (1010/ 1210).22 patients developed HCC during follow-up (22/1210, 1.8 %).Cumulative incidence of HCC of the whole cohort was 0.7% (0.3-1.4) at 5 and 10-year (95 % CI), 2.6% (1.4-4.4) at 20 years and 5.7 % (2.5-10.9)at 30-years of follow-up.The risk of HCC after cirrhosis development increases proportionally to years from the onset of the disease.Age>40 years (HR 5.99, p = 0.02), BMI>30 kg/m 2 (HR 4.11, p = 0.02), splenomegaly (HR 4.03, p = 0.03), and PSC overlap syndrome (HR 8.63, p < 0.001) resulted independent risk factors for HCC development at multivariate analysis balanced by sex.No association was observed between tumor formation and type of treatment, nor activity on liver histology resulted to have any prognostic value. Conclusion:The incidence of HCC in AIH is lower than reported to other chronic liver diseases even after cirrhosis development.Age more than 40 years, obesity, splenomegaly and PSC variant syndrome represent risk factors for HCC development, but further studies are needed to identify predictive tools for stratification of the at-risk population.