Acute Liver Failure from Tumor Necrosis Factor-α Antagonists: Report of Four Cases and Literature Review

for the United States Acute Liver Failure Study Group

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background: Tumor necrosis factor-α antagonists (anti-TNF-α) have been associated with drug-induced liver injury. However, cases of anti-TNF-α-associated acute liver failure have only been rarely reported. Aims: To identify cases of anti-TNF-α-associated acute liver failure and evaluate patterns of liver injury and common characteristics to the cases. Methods: The United States Acute Liver Failure Study Group database was searched from 1998 to 2014. Four subjects were identified. A PubMed search for articles that reported anti-TNF-α-associated acute liver failure identified five additional cases. Results: The majority of individuals affected were female (eight of nine cases). Age of individual ranged from 20 to 53 years. The most common anti-TNF-α agent associated with acute liver failure was infliximab (n = 8). The latency between initial drug exposure and acute liver failure ranged from 3 days to over a year. Of the nine cases, six required emergency LT. Liver biopsy was obtained in seven cases with a preponderance toward cholestatic–hepatitic features; none showed clear autoimmune features. Conclusions: Anti-TNF-α-associated acute liver failure displays somewhat different characteristics compared with anti-TNF-α-induced drug-induced liver injury. Infliximab was implicated in the majority of cases. Cholestatic–hepatitic features were frequently found on pre-transplant and explant histology.

Original languageEnglish (US)
Pages (from-to)1654-1666
Number of pages13
JournalDigestive Diseases and Sciences
Volume63
Issue number6
DOIs
StatePublished - Jun 1 2018

Fingerprint

Acute Liver Failure
Tumor Necrosis Factor-alpha
Chemical and Drug Induced Liver Injury
Liver
PubMed
Histology
Emergencies
Databases
Transplants
Biopsy
Wounds and Injuries
Pharmaceutical Preparations

Keywords

  • Acute liver failure
  • Drug-induced liver injury
  • Liver transplant
  • Tumor necrosis factor-α antagonists

ASJC Scopus subject areas

  • Physiology
  • Gastroenterology

Cite this

Acute Liver Failure from Tumor Necrosis Factor-α Antagonists : Report of Four Cases and Literature Review. / for the United States Acute Liver Failure Study Group.

In: Digestive Diseases and Sciences, Vol. 63, No. 6, 01.06.2018, p. 1654-1666.

Research output: Contribution to journalArticle

for the United States Acute Liver Failure Study Group. / Acute Liver Failure from Tumor Necrosis Factor-α Antagonists : Report of Four Cases and Literature Review. In: Digestive Diseases and Sciences. 2018 ; Vol. 63, No. 6. pp. 1654-1666.
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abstract = "Background: Tumor necrosis factor-α antagonists (anti-TNF-α) have been associated with drug-induced liver injury. However, cases of anti-TNF-α-associated acute liver failure have only been rarely reported. Aims: To identify cases of anti-TNF-α-associated acute liver failure and evaluate patterns of liver injury and common characteristics to the cases. Methods: The United States Acute Liver Failure Study Group database was searched from 1998 to 2014. Four subjects were identified. A PubMed search for articles that reported anti-TNF-α-associated acute liver failure identified five additional cases. Results: The majority of individuals affected were female (eight of nine cases). Age of individual ranged from 20 to 53 years. The most common anti-TNF-α agent associated with acute liver failure was infliximab (n = 8). The latency between initial drug exposure and acute liver failure ranged from 3 days to over a year. Of the nine cases, six required emergency LT. Liver biopsy was obtained in seven cases with a preponderance toward cholestatic–hepatitic features; none showed clear autoimmune features. Conclusions: Anti-TNF-α-associated acute liver failure displays somewhat different characteristics compared with anti-TNF-α-induced drug-induced liver injury. Infliximab was implicated in the majority of cases. Cholestatic–hepatitic features were frequently found on pre-transplant and explant histology.",
keywords = "Acute liver failure, Drug-induced liver injury, Liver transplant, Tumor necrosis factor-α antagonists",
author = "{for the United States Acute Liver Failure Study Group} and Beverley Kok and Lester, {Erica L.W.} and Lee, {William M} and Hanje, {A. James} and Stravitz, {R. Todd} and Safwat Girgis and Vaishali Patel and Peck, {Joshua R.} and Christopher Esber and Karvellas, {Constantine J.}",
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T1 - Acute Liver Failure from Tumor Necrosis Factor-α Antagonists

T2 - Report of Four Cases and Literature Review

AU - for the United States Acute Liver Failure Study Group

AU - Kok, Beverley

AU - Lester, Erica L.W.

AU - Lee, William M

AU - Hanje, A. James

AU - Stravitz, R. Todd

AU - Girgis, Safwat

AU - Patel, Vaishali

AU - Peck, Joshua R.

AU - Esber, Christopher

AU - Karvellas, Constantine J.

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N2 - Background: Tumor necrosis factor-α antagonists (anti-TNF-α) have been associated with drug-induced liver injury. However, cases of anti-TNF-α-associated acute liver failure have only been rarely reported. Aims: To identify cases of anti-TNF-α-associated acute liver failure and evaluate patterns of liver injury and common characteristics to the cases. Methods: The United States Acute Liver Failure Study Group database was searched from 1998 to 2014. Four subjects were identified. A PubMed search for articles that reported anti-TNF-α-associated acute liver failure identified five additional cases. Results: The majority of individuals affected were female (eight of nine cases). Age of individual ranged from 20 to 53 years. The most common anti-TNF-α agent associated with acute liver failure was infliximab (n = 8). The latency between initial drug exposure and acute liver failure ranged from 3 days to over a year. Of the nine cases, six required emergency LT. Liver biopsy was obtained in seven cases with a preponderance toward cholestatic–hepatitic features; none showed clear autoimmune features. Conclusions: Anti-TNF-α-associated acute liver failure displays somewhat different characteristics compared with anti-TNF-α-induced drug-induced liver injury. Infliximab was implicated in the majority of cases. Cholestatic–hepatitic features were frequently found on pre-transplant and explant histology.

AB - Background: Tumor necrosis factor-α antagonists (anti-TNF-α) have been associated with drug-induced liver injury. However, cases of anti-TNF-α-associated acute liver failure have only been rarely reported. Aims: To identify cases of anti-TNF-α-associated acute liver failure and evaluate patterns of liver injury and common characteristics to the cases. Methods: The United States Acute Liver Failure Study Group database was searched from 1998 to 2014. Four subjects were identified. A PubMed search for articles that reported anti-TNF-α-associated acute liver failure identified five additional cases. Results: The majority of individuals affected were female (eight of nine cases). Age of individual ranged from 20 to 53 years. The most common anti-TNF-α agent associated with acute liver failure was infliximab (n = 8). The latency between initial drug exposure and acute liver failure ranged from 3 days to over a year. Of the nine cases, six required emergency LT. Liver biopsy was obtained in seven cases with a preponderance toward cholestatic–hepatitic features; none showed clear autoimmune features. Conclusions: Anti-TNF-α-associated acute liver failure displays somewhat different characteristics compared with anti-TNF-α-induced drug-induced liver injury. Infliximab was implicated in the majority of cases. Cholestatic–hepatitic features were frequently found on pre-transplant and explant histology.

KW - Acute liver failure

KW - Drug-induced liver injury

KW - Liver transplant

KW - Tumor necrosis factor-α antagonists

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