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. 2023 Mar 1;77(3):1036-1065.
doi: 10.1002/hep.32689. Epub 2023 Feb 17.

AASLD practice guidance on drug, herbal, and dietary supplement-induced liver injury

Robert J Fontana  1 , Iris Liou  2 , Adrian Reuben  3 , Ayako Suzuki  4 , M Isabel Fiel  5 , William Lee  6 , Victor Navarro  7
Affiliations

AASLD practice guidance on drug, herbal, and dietary supplement-induced liver injury

Robert J Fontana et al. Hepatology. .
No abstract available

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Conflict of interest statement

Victor Navarro received grants from Zydus. Robert Fontana received grants from Gilead. William Lee consults for SeaGem, GSK, Forma, and Veristat. He received grants from Eiger, Alexion, Gilead, Boehringer Ingelheim, Lipocine, and Camurus.

Figures

FIGURE 1
FIGURE 1
Proposed diagnostic algorithm for patients with suspected DILI. A diagnosis of DILI relies on careful elicitation of clinical history and drug exposures along with exclusion of other more common causes of liver injury. Abbreviations: A1AT, alpha‐1‐antitrypsin; ALP, alkaline phosphatase; ALT alanine aminotransferase; AMA, anti‐mitochondrial antibody; ANA, antinuclear antibody; APAP, acetaminophen; ASMA, anti‐smooth muscle antibody; AST, aspartate aminotransferase; CK, creatine kinase; CMV, cytomegalovirus; EBV, Epstein–Barr virus; HDS, herbal and dietary supplement; HSV, herpes simplex virus; INR, international normalized ratio; LDH, lactate dehydrogenase; T3, triiodothyronine; T4, thyroxine; TB, total bilirubin; TSH, thyroid stimulating hormone; TTG, tissue transglutaminase; ULN, upper limit of normal.
FIGURE 2
FIGURE 2
Examples of histological injury attributed to DILI. (A) Nodular regenerative hyperplasia can be seen with azathioprine and oxaliplatin. Reticulin stain highlights a nodular architecture with nodules made up of hyperplastic hepatocytes characterized by two‐cell‐thick plates that are bordered by atrophic hepatocyte plates. Note that the portal tract (arrow) is in the center of the nodule, termed reverse lobulation (original magnification ×10, reticulin stain). (B) Hepatocytes with ground‐glass like cytoplasm are characterized by smooth homogeneous light pink color as opposed to the typical grainy eosinophilic cytoplasm of normal hepatocytes. These hepatocytes are typically found in zone 3. The development of these is often due to polypharmacy (original magnification ×10, hematoxylin and eosin stain). (C) Photomicrograph showing dilated canaliculi containing bile but no inflammatory infiltrates are present and very rare hepatocytes are noted to be undergoing feathery degeneration. This pattern of injury is reported with drugs such as trimethoprim‐sulfamethoxazole (original magnification ×40, hematoxylin and eosin).
See this image and copyright information in PMC

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References

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