Liver transplantation for drug-induced acute liver failure

M. Biolato, C. Araneo, G. Marrone, A. Liguori, L. Miele, F.R. Ponziani, A. Gasbarrini, A. Grieco

Liver Transplant Medicine, Gastroenterological Area, Gastroenterological and Endocrino-Metabolic Sciences Department, Fondazione Policlinico Universitario Gemelli, Catholic University of the Sacred Heart, Rome, Italy. antonio.grieco@unicatt.it

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• Gastroenterology
• Toxicology

OBJECTIVES: To summarize the different clinical features of drug-induced acute liver failure, the diagnostic work-up, conservative management and the prognostic scores currently used to list patients for liver transplantation.

EVIDENCE AND INFORMATION SOURCES: The current review is based on an analysis of the current literature and the caseload experience of the Authors on this topic.

STATE OF THE ART: Drug-induced liver injury is the leading cause of acute liver failure in the adult population in Western countries, with a transplant-free survival rate of less than 50%. Main subtypes include paracetamol and idiosyncratic drug-induced injury, which differ in epidemiology, clinical course, prognosis and conservative management. In cases of a high likelihood of death, urgent hepatic transplantation is indicated, but the decision whether and when to put a patient with drug-induced acute liver failure on the list for urgent liver transplant is extremely difficult and requires constant interdisciplinary exchange and continuous updating of the clinical picture.

CONCLUSIONS: Intensive management should be done in a clinical tertiary referral center which has a specialized team of hepatologists and a liver transplant center.

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