REVIEW  NEW PERSPECTIVES IN HEPATOLOGY: MANAGEMENT OF COMPLEX LIVER DISEASES 

Minerva Gastroenterology 2021 March;67(1):50-64

DOI: 10.23736/S2724-5985.20.02795-6

Copyright © 2020 EDIZIONI MINERVA MEDICA

lingua: Inglese

Drug induced liver injury: from pathogenesis to liver transplantation

Giacomo GERMANI ✉, Sara BATTISTELLA, Doina ULINICI, Alberto ZANETTO, Sarah SHALABY, Monica PELLONE, Martina GAMBATO, Marco SENZOLO, Francesco P. RUSSO, Patrizia BURRA

Unit of Multivisceral Transplant, Department of Surgery, Oncology and Gastroenterology, University Hospital of Padua, Padua, Italy

Drug induced liver injury (DILI) is a necro-inflammatory liver disease caused by several drugs commonly used in clinical practice, herbs and dietary supplements prescribed for medical purposes. Despite its rarity, it represents the major cause of acute liver failure (ALF) requiring liver transplantation in USA and its frequency is increasing in Europe too. Two types of drug induced liver injury have been recognized: intrinsic and idiosyncratic. Predisposing factors may be classified in environmental, drugs- and individual- related risk factors, with the latter further distinguished in genetics and non-genetics. The liver injury can present with a hepatocellular, cholestatic or mixed pattern of disease. A definitive diagnosis of DILI is, nowadays, one of the main challenging issue in the management of these patients. Diagnosis often is based on suspicion derived from clinical history, biochemical exams and eventually on histological examination from liver biopsy. Score system may be helpful in these setting and new markers are gaining more prominence. Evaluation for liver transplantation is indicated when spontaneous resolution does not occur or in cases of ALF. Overall, the 1-year survival rate following liver transplantation is lower than that seen in patients who have been transplanted for chronic liver failure; however long-term survival is higher compared to other indications.

KEY WORDS: Chemical and drug induced liver injury; Liver transplantation; Liver failure, acute