Current Concepts and Morphological Aspects of Drug Induced Liver Injury

Overview

Currently, the following areas are in the focus of interest in hepatology: study of hepatic stem cells, mechanisms of fibrogenesis and cirrhosis development; mechanisms of the development of steatosis, steatohepatitis and NASH/NAFLD; rejection of liver transplants; diagnosis of autoimmune hepatitis, primary sclerosing cholangitis and primary biliary cirrhosis; diagnosis of hemochromatosis; the importance and relevance of grading and staging of chronic hepatitis. DILI (Drug Induced Liver Injury) is also in the focus of interest. DILI is important because the histology of DILI overlaps almost all areas of liver pathology unrelated to drug injury. Moreover, there is not unified approach to DILI diagnostic and references are almost solely case reports. The diagnosis of DILI is also complicated by lack of information on pharmacological anamnesis of patients, frequent combination of drugs with natural compounds and influence of environmental factors. DILI is a cause of 10 % of acute hepatitis and 15 % of liver failures with subsequent transplantation. Hepatotoxicity is also one of the most important reasons for drug withdrawal.

This review covers basic informations on classification of hepatotoxic drugs, on the system of liver biopsy assessment when DILI is suspected, and it is an overview of the main histologic pictures of liver biopsy with examples of the most important drugs and differential diagnosis.

Key words:
liver – hepatotoxicity – drugs