TY  - JOUR
AU  - Teschke, Rolf
AU  - Eickhoff, Axel
PY  - 2025
DA  - 2025/02/14
TI  - Acute Liver Failure Due to Assumed Drug Induced Liver Injury but Lack of Any Validated Causality Algorithm: Evidence by 36 Cohort Reports with 21,709 Cases
JO  - OBM Transplantation
SP  - 234
VL  - 09
IS  - 01
AB  - Liver transplantation (LT) can be the only option for patients with acute liver failure (ALF) where medical approaches are ineffective. Causes of ALF are multiple and commonly easily detectable, but uncertainty remained on the role of drug-induced liver injury (DILI) within the published ALF cohorts. Therefore, an analysis was undertaken to clarify which drugs may have caused the DILI and how the diagnosis of the liver injury was established. Using the PubMed database and Google Science, the search term of acute liver failure combined with drugs provided 36 publications of ALF cohorts, which included 21,709 DILI cases. Whereas non-drug causes were detectable by specific diagnostic biomarkers, the diagnosis of DILI among the ALF cohorts was neglected, as evidenced by the lacking use of a validated diagnostic algorithm like the Roussel Uclaf Causality Assessment Method (RUCAM), best qualified to verify causality for individual drugs or combined drugs. This lack of firm diagnosis leads to a long list of drugs with highly questionable causality of suspected DILI, prevents calculation of incidence or prevalence data of DILI among ALF cohorts, and cannot help find an appropriate therapy for selected cases of drug-induced autoimmune hepatitis (DIAIH) or overdosed N-acetyl-para-aminophenol (APAP) also known as paracetamol, aiming to prevent LT. Under discussion is also the high rate of indeterminate cases of up to 78% among the published cohorts, which confounds any quantitative approach in this setting. In conclusion, there is much room for improvement in future ALF cohorts, requiring the application of validated tools.
SN  - 2577-5820
UR  - https://doi.org/10.21926/obm.transplant.2501234
DO  - 10.21926/obm.transplant.2501234
ID  - Teschke2025
ER  -