Published online Mar 27, 2026. doi: 10.4254/wjh.v18.i3.117367
Revised: January 27, 2026
Accepted: February 13, 2026
Published online: March 27, 2026
Processing time: 111 Days and 5 Hours
Autoimmune liver diseases, including autoimmune hepatitis, primary biliary cholangitis, and primary sclerosing cholangitis, have traditionally been regarded as disorders of young or middle-aged adults. However, the progressive aging of the global population has revealed a substantial and increasing number of cases diagnosed at ever older ages. Older adults frequently present with atypical or non-specific symptoms, are more likely to be diagnosed at advanced stages, and often exhibit a distinct biochemical profile compared with younger patients. In particular, the recent study by Delgado et al underscores these differences in late-onset autoimmune hepatitis, demonstrating a higher rate advanced fibrosis at presentation and diagnostic delay in elderly individuals. This editorial aims to highlight these observations, as these characteristics create unique diagnostic challenges and may negatively influence long-term outcomes. Treatment remains effective with standard first-line regimens; however, therapeutic decisions must be carefully individualized due to comorbidities, polypharmacy, and an increased vulnerability to treatment-related adverse events. Recognizing age-specific clinical patterns and adapting management strategies accordingly is essential to optimize care in this growing and frequently overlooked patient population.
Core Tip: Autoimmune liver diseases are increasingly relevant in older adults, with changing epidemiology and rising incidence, including presentation peaks in this age group. Clinical manifestations range from unusual presentations, acute liver failure, and acute hepatitis to more common indolent forms with minimal symptoms. Serologic testing does not differ from younger patients, but due to comorbidities, liver biopsy remains essential. First-line treatment generally does not change and is often effective, although older adults are more vulnerable to steroid-related complications and polypharmacy. Liver transplantation remains an option. However, this population is still understudied, and future research should incorporate comprehensive geriatric assessment.