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EASL Clinical Practice Guidelines: Drug-induced liver injury
Raúl J. Andrade Guruprasad P. Aithal, Einar S. Björnsson, Neil Kaplowitz, Gerd A. Kullak-Ublick, Dominique Larrey Tom H. Karlsen Raúl J. Andrade Guruprasad P. Aithal, Einar S. Björnsson, Neil Kaplowitz, Gerd A. Kullak-Ublick, Dominique Larrey Tom H. Karlsen Raúl J. Andrade Guruprasad P. Aithal, Einar S. Björnsson, Neil Kaplowitz, Gerd A. Kullak-Ublick, Dominique Larrey Tom H. Karlsen Raúl J. Andrade Guruprasad P. Aithal, Einar S. Björnsson, Neil Kaplowitz, Gerd A. Kullak-Ublick, Dominique Larrey Tom H. Karlsen Journal of Hepatology DOI: /j.jhep Copyright © 2019 European Association for the Study of the Liver Terms and Conditions
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Fig. 1 Mechanistic relationship between intrinsic and idiosyncratic DILI. A common prerequisite for intrinsic toxicity and idiosyncratic DILI is the metabolism of lipophilic drugs in the liver, generating reactive metabolites which lead to initial consequences, such as covalent binding, oxidative stress, stress kinase signalling and organelle stress responses (mitochondria and ER) which either overwhelm defences and lead directly to necrosis or apoptosis or elicit an adaptive immune response to drug-adducts (haptens) in genetically susceptible individuals. DILI, drug-induced liver injury; ER, endoplasmic reticulum; GSH, glutathione; ROS, reactive oxygen species. Journal of Hepatology DOI: ( /j.jhep ) Copyright © 2019 European Association for the Study of the Liver Terms and Conditions
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Fig. 2 Stepwise approach to DILI diagnosis. ALP, alkaline phosphatase; ALT, alanine aminotransferase; Chol, cholestatic injury pattern; CMV, cytomegalovirus; EBV, Epstein-Barr virus; HAV, hepatitis A virus; HBV, hepatitis B virus; HCV, hepatitis C virus; HDS, herbal and dietary supplements; Hep, hepatocellular injury pattern; HEV, hepatitis E virus; IgG, immunoglobulin G; Mix, mixed injury pattern; OTC, over-the-counter drugs; ULN, upper limit of normal. Journal of Hepatology DOI: ( /j.jhep ) Copyright © 2019 European Association for the Study of the Liver Terms and Conditions
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