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Alternative medicine-induced liver injury linked to high LT rate, lower transplant-free survival

Source/Disclosures Source: Hillman L, et al. Am J Gastroenterol. 2016;doi:10.1038/ajg.2016.114. ADD TOPIC TO EMAIL ALERTS Receive an email when new articles are posted on . Please provide your email address to receive an email when new articles are posted on Subscribe ADDED TO EMAIL ALERTS You've successfully added to your alerts. You will receive an email when new content is published.



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Patients with complementary and alternative medicines-induced liver injury had higher rates of liver transplantation compared with prescription medication-induced injury. Additionally, a lower transplant-free survival was observed, according to recently published findings.

“This study highlights the increasing incidence of [complementary and alternative medicines]-induced liver injury and emphasizes the importance of early referral and evaluation for liver transplantation when [complementary and alternative medicines]-induced liver injury is suspected,” Luke Hillman, MD, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, and colleagues wrote.

Researchers collected and evaluated data of patients with suspected acute liver injury enrolled in the Acute Liver Failure Study Group registry between January 2008 and April 2015. They divided patients into two categories of drug-induced liver injury (DILI): those who had taken complementary and alternative medicines (CAM) or prescription medications.

In addition to data comparison between the groups, researchers performed a subgroup analysis on patients with acute liver failure, including patients who progressed from acute liver injury to failure.

The final analysis included 251 patients with acute liver injury, of whom 83.7% had taken prescription medications (n = 210) and 16.3% took CAMs (n = 41). The most frequently used prescription medications were antiviral medications and antimicrobials (48.6%), whereas herbal supplements accounted for 63.4% of all patients with CAM-induced liver injury.

Between 1998 and 2015, the number of CAM-induced cases increased from 12.4% (1998 to 2007) to 21.1% (2007 to 2015; P = .047). More patients with CAM-induced injury were listed for liver transplantation (65.9%) compared with patients with prescription-related injury (47.1%). At 21 days, more patients in the CAM-induced group underwent LT (56.1%) compared with the prescription-induced group (31.9%; P < .005). Nine patients in the CAM-induced group died, despite five of them undergoing LT.

In the subgroup analysis, researchers observed a higher LT rate between CAM-induced patients with acute liver failure (61.1%) compared with the prescription-induced patients with acute liver failure (35.6%; P < .005), in addition to lower 21-day transplant-free survival (17.4% vs. 34.4%; P = .044).

“Within the CAM group, those with 21-day transplant-free survival were more likely to have [acute liver injury] than [acute liver failure] when compared with those transplanted or dead,” the researchers wrote. “Additionally, this subset had significantly lower median BMIs, median [international normalized ratios] and subsequently lower MELD scores.”

The researchers concluded: “Given the significant potential for morbidity and mortality, patients presenting with suspected CAM-induced severe liver injury or liver failure should be considered for early referral and rapid evaluation at a liver transplant center. … We also propose that stricter reporting of CAM-induced DILI and better characterization of the mechanisms of hepatotoxicity from these compounds would help limit the serious outcomes associated with such over-the-counter products.” – by Melinda Stevens

Disclosure: Hillman reports no relevant financial disclosures. Please see the study for all other researchers’ relevant financial disclosures.