Drug-induced liver injury: A management position paper from the Latin American Association for Study of the liver
Date
2021Author
Bessone, Fernando
Hernandez, Nelia
Tagle, Martin
Arrese, Marco
Parana, Raymundo
Méndez-Sánchez, Nahum
Ridruejo, Ezequiel
Mendizabal, Manuel
Dagher, Lucy
Contreras, Fernando
Fassio, Eduardo
Pessoa, Mario
Brahm, Javier
Silva, Marcelo
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Idiosyncratic drug-induced liver injury (DILI) caused by xenobiotics (drugs, herbals and dietary supplements)
is an uncommon cause of liver disease presenting with a wide range of phenotypes and
disease severity, acute hepatitis mimicking viral hepatitis to autoimmune hepatitis, steatosis, fibrosis
or rare chronic vascular syndromes. Disease severity ranges from asymptomatic liver test abnormalities
to acute liver failure. DILI has been traditionally classified in predictable or intrinsic (dose-related) or
unpredictable (not dose-related) mechanisms. Few prospective studies are assessing the real prevalence
and incidence of hepatotoxicity in the general population. DILI registries represent useful networks used
for the study of liver toxicity, aimed at improving the understanding of causes, phenotypes, natural history,
and standardized definitions of hepatotoxicity. Although most of the registries do not carry out
population-based studies, they may provide important data related to the prevalence of DILI, and also
may be useful to compare features from different countries. With the support of the Spanish Registry of
Hepatotoxicity, our Latin American Registry (LATINDILI) was created in 2011, and more than 350 DILI
patients have been recruited to date. This position paper describes the more frequent drugs and herbsinduced
DILI in Latin America, mainly focusing on several features of responsible medicaments. Also, we
highlighted the most critical points on the management of hepatotoxicity in general and those based on
findings from our Latin American experience in particular.
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