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Introduction Sarcoidosis is a multisystem granulomatous disease with frequent but often underrecognized hepatic involvement. Although most patients have mild disease, a subset progresses to advanced liver disease, highlighting the need to identify predictors of severe hepatic involvement.Methods We conducted a retrospective study including patients with hepatic sarcoidosis managed between 2005 and 2025. Data collected included demographics, clinical, biological, imaging, endoscopic, histological, therapeutic, and outcomes.Advanced liver disease was defined by at least one of:Portal hypertension on imaging (splenomegaly or collateral circulation)Esophageal varices on endoscopyHepatic decompensation (ascites or digestive bleeding)Comparisons between patients with and without ALD were analyzed using Fisher’s exact test (p<0.05).Results Cohort: 16 patients; mean age 51 years; 100% female.Comorbidities: 92% (mainly diabetes), not associated with ALD.Clinical findings: splenomegaly in 42%, collateral circulation or hepatomegaly in 17%; clinical parameters were not independently associated with ALD.Biology: cholestasis in 75%, cytolysis in 33%; cytolysis showed a trend toward ALD (p=0.08).Imaging & endoscopy: portal hypertension on US in 50%, chronic liver disease in 58%, esophageal varices in 58%—by definition, associated with ALD.Histology: all biopsies showed non-caseating granulomatous hepatitis; fibrosis staging available in a subset.Treatment: Ursodeoxycholic, corticosteroids, or combination; treatment modality was not significantly associated with ALD.Outcomes: ALD observed in 50%; complications included ascites and digestive bleeding; follow-up limited by loss to follow-up in 7 patients.Conclusion Advanced liver disease is frequent in hepatic sarcoidosis. Although no independent predictor reached statistical significance, cytolysis showed a trend toward severe hepatic involvement. These findings emphasize the importance of systematic hepatic evaluation to identify patients at risk of advanced disease. Interpretation is limited by small sample size, highlighting the need for larger studies.