Clinical, etiological, and demographic aspects of cirrhosis in South America: a report from the South American Liver Research Network

INTRODUCTION AND OBJECTIVES: Cirrhosis is a major global public health concern. In South America, previous studies have identified alcohol-related liver disease (ALD) and chronic hepatitis C as the leading causes. This study describes and characterizes a contemporary South American cohort of patients with cirrhosis, focusing on the current spectrum of etiologies, demographic aspects, and the frequency of complications. PATIENTS AND METHODS: This was a multicenter, retrospective cohort study conducted across 11 centers in 6 South American countries. Patients included were adults (>18 years) with confirmed cirrhosis, and a minimum of two follow-up visits. RESULTS: A total of 1780 patients (50.7% male, median age 61 years) were evaluated. Metabolic dysfunction-associated steatotic liver disease (MASLD) was the leading cause of cirrhosis (34.1%), followed by viral etiology (19.8%), autoimmune liver disease (18%), and ALD alone (16%). Comorbidities were highly prevalent, with self-reported alcohol intake in 37.8%, hypertension in 36.2%, and diabetes in 33.7%. Nearly two-thirds of patients (63.5%) developed at least one complication, with ascites being the most common (43.5%). Only 28.1% of the cohort underwent pre-transplant evaluation. CONCLUSIONS: In this contemporary South American cohort, MASLD has emerged as the leading cause of cirrhosis, and autoimmune disease affected nearly one-fifth of individuals with cirrhosis. The high burden of complications, with nearly two-thirds of patients developing at least one, and the low rate of pre-transplant evaluation suggest a significant unmet need for timely diagnosis and advanced care in the region.