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Background The clinical impact of hepatic steatosis (HS) among patients with autoimmune liver disease (AILD) remains unclear. We aim to determine the HS’s prevalence and its clinical impact on treatment response and outcomes in patients with AILD.Methods We systematically searched three electronic databases from inception till 17 December 2025, including all studies that reported the prevalence, clinical impact, or treatment response of AILD patients with concomitant HS. The temporal trend of HS prevalence was analyzed using a quasi-Poisson regression model, with annual percent changes (APC, %) calculated.Results Overall, 44 studies, comprising 19,898 patients with autoimmune hepatitis (AIH), primary biliary cholangitis (PBC), and primary sclerosing cholangitis (PSC) were included. The pooled prevalence of HS in patients with AIH, PBC, and PSC was 27.3%, 32.9% and 21.6%, respectively ( IDDF2026-ABS-0087 Figure 1). HS prevalence has significantly increased among PBC patients since 2010 (APC: +37.4%) (IDDF2026-ABS-0087 Figure 2). While concomitant HS was associated with a higher risk of hepatic decompensation (OR: 1.6, 95%CI: 1.3-2.1, I2=0%) (IDDF2026-ABS-0087 Figure 3) and hepatocellular carcinoma (OR: 1.8, 95%CI: 1.3-2.6, I2= 0%) (IDDF2026-ABS-0087 Figure 4) in patients with AIH, HS did not influence the clinical outcomes in patients with PBC. Treatment response in AIH and PBC was not influenced by concomitant HS. Available data on PSC with concomitant HS were insufficient to assess its association with clinical outcomes.Conclusions AIH patients with concomitant HS had worse outcomes than those without HS, whereas HS did not influence the clinical outcomes in patients with PBC. Future research evaluating the impact of HS on PSC and overlap syndrome is much needed.Abstract IDDF2026-ABS-0087 Figure 1Abstract IDDF2026-ABS-0087 Figure 2Abstract IDDF2026-ABS-0087 Figure 3Abstract IDDF2026-ABS-0087 Figure 4