Long-term sequelae of drug-induced liver injury

Einar Stefán Björnsson*, Raul J. Andrade

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Drug-induced liver injury (DILI) has a very variable clinical and biochemical phenotype and differs widely in severity, from mild injury to life-threatening liver failure. Chronic injury has also been reported to occur at a variable frequency, ranging from 3.4% to 39%, 6-12 months after discontinuing the implicated agent. This wide range is probably related to various definitions of chronic liver injury and variable selection of patients. The long-term sequalae of this chronic injury in terms of morbidity and mortality are unclear, although rare vanishing bile duct syndrome is associated with an unfavourable prognosis, with increased risk of chronic liver failure and need for liver transplantation. Other forms of long-term sequalae associated with DILI are progressive fibrosis, autoimmune-like hepatitis, secondary sclerosing cholangitis, sinusoidal obstruction syndrome and, as a common final stage, the development of cirrhosis, portal hypertension and its complications. Immune checkpoint inhibitors, which can cause an autoimmune-like phenotype have also recently been shown to cause sclerosing cholangitis with cytotoxic T CD8+ cell infiltration in biliary tracts. DILI has been shown to have a significant impact on health-related quality of life but very little is known about its psychological consequences in the long-term. Further investigations with structured long-term follow-up and periodic quality of life surveys are needed to assess the impact of DILI on psychological outcomes, particularly in those with chronic sequelae.

Original languageEnglish
Pages (from-to)435-445
Number of pages11
JournalJournal of Hepatology
Issue number2
Publication statusPublished - 1 Feb 2022

Bibliographical note

The authors received no financial support to produce this manuscript.

Publisher Copyright:
© 2021 European Association for the Study of the Liver

Other keywords

  • cirrhosis
  • DILI
  • drug-induced autoimmune hepatitis
  • hepatotoxicity
  • psychological disability
  • secondary sclerosing cholangitis
  • sinusoidal obstruction syndrome
  • vanishing bile duct syndrome


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