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When amyloidosis affects the liver, it’s called hepatic amyloidosis. In most cases, liver-related symptoms of amyloidosis are mild. However, serious problems like liver failure can occasionally happen.
Keep reading to learn how amyloidosis can affect the liver and what symptoms to watch for.
Hepatic amyloidosis occurs when amyloid deposits build up in the liver. This can lead to liver problems that range from mild to serious.
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Amyloidosis is a condition in which abnormal proteins clump together to form protein fibers called amyloid fibrils. When these fibrils collect in just one part of the body — such as the skin — it’s called localized amyloidosis.
In most cases, however, amyloid fibrils spread to affect an entire organ or multiple organs. This is called systemic amyloidosis. Hepatic amyloidosis is one possible effect of systemic amyloidosis.
People with different types of amyloidosis can develop symptoms that affect the liver. The type of amyloid protein involved plays a big role in how severe the liver involvement is and how quickly it progresses.
Read on to learn how the liver is affected in different types of amyloidosis.
Hepatic amyloidosis is most common in people with amyloid light-chain (AL) amyloidosis. As many as 90 percent of people with AL amyloidosis show evidence of amyloid deposits in their livers.
AL amyloidosis develops when a type of blood cell called a plasma cell makes abnormal pieces of antibodies called light chain proteins. In most people with AL amyloidosis, the liver isn’t the only organ affected. These faulty proteins can build up in multiple organs, including the liver, heart, kidneys, and the digestive system.
AA amyloidosis (also called secondary amyloidosis) is linked to long-term inflammation that causes high levels of serum amyloid A protein in the blood. Over time, this excess serum amyloid A can become abnormal and form harmful amyloid deposits in organs like the liver.
About 60 percent of people with AA amyloidosis have some level of liver involvement.
In both AL and AA amyloidosis, amyloid proteins can collect in liver tissue and the walls of blood vessels. Over time, these deposits can damage hepatocytes (liver cells), hindering proper functioning and causing them to die.
Hepatic amyloidosis can cause problems when amyloid proteins build up in the liver — a process known as amyloid fibril deposition. These deposits can interfere with how the liver works.
Studies looking for microscopic amyloid deposits in the livers of people with amyloidosis typically show that many people have liver involvement. However, it’s far less common for people to have noticeable symptoms of hepatic amyloidosis. But even without obvious symptoms, liver damage may still be happening.
Signs and symptoms of hepatic amyloidosis may include:
Hepatomegaly is the medical term for an enlarged liver. It’s one of the most common signs of hepatic amyloidosis. Studies estimate that between 57 percent and 83 percent of people with hepatic amyloidosis have an enlarged liver.
In some people, the spleen can also be enlarged.
Many people with an enlarged liver don’t feel any different. In hepatic amyloidosis, the size of the liver doesn’t always match the severity of symptoms.
If you do notice symptoms of an enlarged liver, they may include a feeling of fullness or bloating, or pain in the upper right side of the abdomen. A healthcare provider may be able to feel an enlarged liver or spleen during a physical examination, or it can be visualized on imaging studies such as an ultrasound.
Liver function tests (LFTs) are blood tests that measure substances related to liver health. High levels of certain liver enzymes can be a sign that amyloidosis is affecting the liver.
The most common abnormal result in hepatic amyloidosis is a high alkaline phosphatase (ALP) level. Other enzymes, such as aspartate aminotransferase (AST) and gamma-glutamyltransferase (GGT), may also be elevated.
People with hepatic amyloidosis may have general symptoms related to systemic (whole-body) amyloidosis, such as:
Systemic amyloidosis often affects more than one organ, so if you have hepatic amyloidosis, you may also experience symptoms related to amyloid buildup in other parts of the body.
The organs most commonly affected by AL amyloidosis include the heart, kidney, nervous system, and gastrointestinal tract.
Between 70 percent and 80 percent of people with hepatic amyloidosis have another health condition related to systemic amyloidosis, including:
The symptoms of hepatic amyloidosis can be caused by other health conditions, so it’s important to get a definitive diagnosis.
A liver biopsy can confirm amyloid in the liver, but doctors often use biopsies from safer sites, such as abdominal fat or bone marrow. These results may be considered along with liver tests and imaging, reserving liver biopsy for select cases.
During a liver biopsy, a healthcare provider removes a small sample of tissue. The tissue is stained with special Congo red dye and examined under a microscope using polarized light to look for signs of amyloid deposits.
Your healthcare team will order different tests to learn if hepatic amyloidosis or another condition is the cause of your symptoms, including:
New treatment options for hepatic amyloidosis have significantly improved the outlook for hepatic amyloidosis in recent years. However, hepatic amyloidosis may present differently in each person, so your treatment plan depends on your type of amyloidosis, your symptoms, and which organs are affected.
Current first-line care for AL amyloidosis includes daratumumab and hyaluronidase-fihj (Darzalex Faspro) used with bortezomib, cyclophosphamide, and dexamethasone. The drug combination received approval from the U.S. Food and Drug Administration (FDA) in 2025 to treat newly diagnosed AL amyloidosis, the most common type that affects the liver.
There are several other treatments for AL amyloidosis:
Modern treatments that suppress the production of abnormal light chains can reduce protein deposits over time, and organ function may improve.
It’s important to remember that additional treatments may be needed to address any complications. For example, if you have signs of liver failure or portal hypertension, your doctor may prescribe medications to reduce fluid buildup or lower blood pressure.
While the outlook (prognosis) for people with liver amyloidosis has improved significantly with modern treatments, it varies greatly between individuals. Your outlook may be dependent on factors such as whether amyloidosis affects your heart, test results showing your liver function stage, overall disease stage, and how your disease responds to therapies.
Hepatic amyloidosis can be serious, especially when the liver is affected by systemic amyloidosis. Liver involvement often signals a more advanced disease, and, in some cases, liver transplantation may be a treatment option.
Although liver damage can be life-threatening, heart and kidney complications are more commonly the cause of death.
It’s important to remember that amyloidosis affects everyone differently. Talk with your amyloidosis specialist about how your specific symptoms and treatment plan may impact your outlook and life expectancy.
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