Drug induced liver injury natural history, complications and prognosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rachita Navara, M.D. [2]

The clinical course of drug induced liver injury varies based on causative drug.^[1] There is a hallmark latent period between the initiation of the drug (“the challenge”) and the development of either symptoms or, more commonly, asymptomatic elevations in serum alanine aminotransferase. Liver injury typically recurs if the drug is reintroduced in the future, often with greater severity that could be life-threatening. Prompt withdrawal of the offending drug leads to complete resolution in 90% of patients, with no long-term sequelae.

There is a hallmark latent period between the initiation of the drug (“the challenge”) and the development of either symptoms or, more commonly, asymptomatic elevations in serum alanine aminotransferase. Once the diagnosis of drug induced liver injury is established and the inciting drug is withdrawn, the “dechallenge” or clinical improvement is relatively immediate. Liver injury typically recurs if the drug is reintroduced in the future, often with greater severity that could be life-threatening.

The main complication that can develop as a result of drug induced liver injury is chronic liver failure in 5-10% of patients, particularly if they have preexisting liver disease. Up to 10% of patients with drug induced liver injury do not survive the initial injury or require liver transplantation. Overall, complications are dependent on the inciting drug and patient risk factors.

Prompt withdrawal of the offending drug leads to complete resolution in 90% of patients, with no long-term sequelae.