Chronic Drug-Induced Liver Injury: Updates and Future Challenges

Abstract

Chronic drug-induced liver injury (DILI), defined as DILI with persistent liver injury more than one year after the first onset by the latest European guidelines, is a notable challenge globally with big issues of defining causality and establishing effective treatment. About 20% of patients with DILI develop into chronic DILI. Chronic DILI manifests as persistent or repeated inflammatory or diminishing bile ducts, even progresses to cirrhosis and needs liver transplantation eventually. However, research on chronic DILI over the last decades is still lacking, and the incidence, phenotypes, mechanisms, risk factors, and treatment have not been fully understood. In this paper, we reviewed the definition of chronic DILI, updated clinical studies in terms of incidence, special manifestations, and promising risk factors of chronic DILI, along with the recent progress and challenges in glucocorticoid therapy.

Keywords: chronic drug-induced liver injury; definition; glucocorticoid; incidence; manifestations.

FIGURE 1

Schematic diagram of ALT fluctuation in three classic patients with acute DILI, chronic DILI with persistent episode of liver abnormality, and chronic DILI with multiple episodes of liver abnormality. ALT values during the 12 months from DILI onset. Each time interval includes 1 month.