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

5 Scopus citations

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

Keywords

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

ASJC Scopus subject areas

  • Physiology
  • Gastroenterology

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