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Translating new knowledge on drug-induced liver injury into clinical practice
  1. Nelia Hernandez1,
  2. Yessica Pontet1,
  3. Fernando Bessone2
  1. 1 Gastroenterology and Hepatology, Facultad de Medicina, Hospital de Clínicas, UdelaR, Montevideo, Uruguay
  2. 2 Gastroenterology and Hepatology, University of Rosario School of Medicine, Rosario, Argentina
  1. Correspondence to Prof Fernando Bessone, Gastroenterology and Hepatology, University of Rosario School of Medicine, Rosario 11600, Argentina; bessonefernando{at}


Drug-induced liver injury (DILI) is one of the main reasons for drug withdrawal from the market, and a cause of worldwide morbidity. Although several issues on DILI are still unsolved, there have been significant advances in new definitions and diagnosis tools. DILI is the result of a complex interaction between genetic and environmental factors, and constitutes an expanding area of investigation. DILI can mimic virtually all known hepatopathies, including vascular disorders and liver tumours. As part of this broad spectrum of clinical presentations, DILI severity ranges from asymptomatic elevations of aminotransferases to acute liver failure. Although biomarkers are emerging as valuable diagnostic tools, they are not available in clinical practice. Accurate DILI diagnosis is a challenging issue, particularly the establishing of causal relationships with the culprit agent and the exclusion of competing causes of liver injury. Given that the understanding of the mechanisms inducing DILI is growing, and both DILI causality assessment scales and the performance of international DILI networks have been improved, hepatotoxicity may be recognised earlier in clinical practice. In this review, advances and results obtained by DILI registries around the world, case characterisations, particularly those relevant to newer definitions in DILI, and the behaviour of chronic liver disease induced by drugs will be updated. In addition, recently published data on herbal and dietary supplements and new predictive scores for acute liver failure assessment will also be discussed.

  • Hepatotoxicity
  • drug-induced liver injury
  • hepatitis
  • acute liver failure and cholestasis

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  • Contributors FB proposed the title, designed the outline, contributed by writing part of the manuscript and submitted the review. NH and YP made up the tables and wrote a part of the manuscript. All the authors reviewed literature regarding recent advances in DILI, read and approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Commissioned; externally peer reviewed.