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Drug-Induced Liver Injury: Understanding the Different Immune-Mediated Phenotypes and Clinical Management

  • Drug-Induced Liver Injury (NP Chalasani and MS Ghabril, Section Editors)
  • Published:
Current Hepatology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

The aim of this manuscript is to review two immune-mediated drug-induced liver injury (DILI) phenotypes, immune-allergic DILI (IA-DILI) and DILI with autoimmune hepatitis features (DILI-AIH), which are poorly defined and can lead to significant morbidity and mortality.

Recent Findings

Recent information on this topic improves the understanding of IA-DILI and DILI-AIH regarding risk factors, associated medications, clinical presentations, histopathologic findings, and management strategies.

Summary

Although the pathogenesis and specific mechanisms remain elusive, clinical and pathological advancements in our understanding of IA-DILI and DILI-AIH have provided clinicians with added tools for the diagnosis and management of these diseases. Further studies are needed to improve our understanding of immune-mediated DILI.

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Abbreviations

DILI:

Drug-induced liver injury

IA-DILI:

Immuno-allergic DILI

DILI-AIH:

Drug-induced autoimmune hepatitis

I-DILI:

Idiosyncratic DILI

FDA:

Food and Drug Administration

ALF:

Acute liver failure

APC:

Antigen-presenting cells

TCR:

T cell receptor

HLA:

Human leukocyte antigen

NSAID:

Nonsteroidal anti-inflammatory drug

TEN:

Toxic epidermal necrolysis

DRESS:

Drug reaction with eosinophilia and systemic symptoms

ESR:

Erythrocyte sedimentation rate

CRP:

C-reactive protein

CAM/C:

Complementary and alternative medications and Chinese medications

AIH:

Autoimmune hepatitis

ANA:

Anti-nuclear antibody

ASMA:

Anti-smooth muscle antibody

LKM:

Liver-kidney mitochondrial

CYP:

Cytochrome P450

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Acknowledgements

This research was supported by the intramural research programs of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and the National Cancer Institute (NCI) of the National Institutes of Health (NIH).

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Authors and Affiliations

  1. Digestive Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, 10 Center Drive, Bldg. 10, Room 5-2740, Bethesda, MD, 20892, USA

    Ben L. Da

  2. Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, 10 Center Drive, Bldg. 10, Room 5-2740, Bethesda, MD, 20892, USA

    Gil Ben-Yakov & Christopher Koh

  3. Laboratory of Pathology, National Cancer Institute, National Institutes of Health, 10 Center Drive, Bldg. 10, Room 2B44, Bethesda, MD, 20892, USA

    David Kleiner

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Da, B.L., Ben-Yakov, G., Kleiner, D. et al. Drug-Induced Liver Injury: Understanding the Different Immune-Mediated Phenotypes and Clinical Management. Curr Hepatology Rep 17, 235–244 (2018). https://doi.org/10.1007/s11901-018-0407-9

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