O-28 DRUG-INDUCED LIVER INJURY IN LATINAMERICA: First ten years’ experience of the ongoing LATINDILI Network

Bessone, Fernando; Hernandez, Nelia; Parana, Raymundo; Mendizabal, Manuel; Sanchez, Adriana; Nunes, Vinicius; Ridruejo, Ezequiel; Schiodi, Daniela; Santos, Genario; Fassio, Eduardo; I., Schinoni Maria; Tanno, Hugo; Tagle, Martin; Montes, Pedro; Arrese, Marco; Mendez-Sanchez, Nahum; Brahm, Javier; Girala, Marcos; Lizarzábal M., Isabel; Mengual, Edgardo; Carrera, Enrique; Contreras, Fernando; Medina-Caliz, Inmaculada; Robles-Díaz, Mercedes; Ortega-Alonso, Aida; García-Cortes, Miren; Alvarez-Alvarez, Ismael; Niu, Hao; Bonilla, Elvira; Lucena M., Isabel; J., Andrade Raul

doi:10.1016/j.aohep.2021.100515

ISSN: 1665-2681

Annals of Hepatology (AoH) is an international, open access journal published bi-monthly with funds from the Fundación Clínica Médica Sur. It is the official journal of the Mexican Association of Hepatology (AMH), the Latin American Association for the Study of the Liver (ALEH), the Canadian Association for the Study of the Liver (CASL) and the Czech Society of Hepatology (CSH). AoH publishes editorials, opinions, concise reviews, original articles, brief reports, letters to the editor, news from affiliated associations, clinical practice guidelines and summaries of congresses in the field of Hepatology.

Topics covered by AoH include alcoholic liver disease, autoimmune hepatitis, biliary diseases, drug-induced liver injury, genetic liver diseases, NAFLD/NASH and viral hepatitis (HAV, HBV, HCV, HDV, HEV). Our journal seeks to publish articles on basic clinical care and translational research focused on preventing rather than treating the complications of end-stage liver disease.

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Fernando Bessone1, Nelia Hernandez2, Raymundo Parana3, Manuel Mendizabal4, Adriana Sanchez2, Vinicius Nunes3, Ezequiel Ridruejo5, Daniela Schiodi2, Genario Santos3, Eduardo Fassio6, Schinoni Maria I.3, Hugo Tanno1, Martin Tagle7, Pedro Montes8, Marco Arrese9, Nahum Mendez-Sanchez10, Javier Brahm11, Marcos Girala12, Isabel Lizarzábal M.13, Edgardo Mengual13..., Enrique Carrera14, Fernando Contreras15, Inmaculada Medina-Caliz16, Mercedes Robles-Díaz16, Aida Ortega-Alonso16, Miren García-Cortes16, Ismael Alvarez-Alvarez16, Hao Niu16, Elvira Bonilla16, Isabel Lucena M.16, Andrade Raul J.16Ver más

1 Hospital Provincial del Centenario, University of Rosario School of Medicine, Rosario, Argentina

2 Clínica de Gastroenterología, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay

3 Hospital Universitário Prof. Edgard Santos-UFBA, Salvador, Brazil

4 Hospital Universitario Austral, Buenos Aires, Argentina

5 Centro de Educación Médica e Investigaciones Clínicas, Buenos Aires, Argentina

6 Hospital Alejandro Posadas, Buenos Aires, Argentina

7 Clínica Anglo Americana, Lima, Perú

8 Hospital Nacional Daniel Alcides Carrion, Callao, Perú

9 Departamento de Gastroenterología. Facultad de Medicina Pontificia Universidad Católica de Chile, Chile

10 Fundación Clínica Médica Sur, Mexico City, Mexico

11 Hospital Clínico Universitario de Chile, Chile

12 Hospital de Clínicas, Asunción del Paraguay, Paraguay

13 Hospital Universitario de Maracaibo, Maracaibo, Venezuela

14 Hospital de Especialidades Eugenio Espejo, Quito, Ecuador

15 Universidad Nacional Pedro Henriquez, Santo Domingo, República Dominicana

16 Servicios de Aparato Digestivo y Farmacología Clínica, Hospital Universitario Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga-IBIMA, Universidad de Málaga, Málaga, Spain. CIBERehd, Madrid, Spain

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Special issue

This article is part of special issue:

Vol. 24. Issue S1

Abstracts of the 2021 Annual meeting of the ALEH (Asociación Latinoamericana para el Estudio del Hígado)

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Introduction

In 2011, the Latin-American DILI-Network (LATINDILIN) set up under the guidance of the Spanish DILI Registry a network of hepatologists to prospectively identify and characterize DILI patients.

Aim

To evaluate the drugs more frequently associated with DILI in LA, clinical phenotype and outcome.

Methods

Demographics, clinical and biochemical parameters of all cases included in the LATINDILI Network were analysed according to the type of liver injury (hepatocellular, Hep; cholestatic, Chol and mixed, Mix).

Results

404 DILI cases were included. Anti-infectives (31%), musculoskeletal system drugs (13%) and herbal products (9.2%) were the main causative therapeutic drug classes. Mean age was 49 years (female sex, 61%). Hep injury predominated (62%) whereas Chol and Mix patterns were 24% and 15% of cases, respectively. Chol patients (mean age 56y) were older than Hep and Mix cases (47 and 50, p<0.05). Jaundice was more prevalent in Chol and Mix injury than in Hep cases (65% vs 75% vs 58%, respectively, p=0.062), though no differences in hospitalization rates were observed (Hep 43%, Chol and Mix 46%, p=0.867). Of note, 12 cases, mostly Hep, had a positive rechallenge. Positive autoantibodies were more common in Hep cases (25% vs Chol 9.1% vs Mix 19%, p=0.010), with nitrofurantoin/herbal products as the most common causative agents. Hep cases showed a higher risk of severe/fatal injury (18% vs 6.0% and 1.8% in Chol and Mix cases, respectively, p<0.001). The new Hy's law performed as expected, with 14% of ALF/Tx cases. Hep cases more frequently died from liver-related death (3.5%) compared with Chol (1.1%) and Mix (0) cases.

Conclusions

In Latin-American DILI cases with Hep pattern predominated, showing a higher severity and most frequent inadvertent re-exposition. The LATINDILI Network is proving as an important tool for the characterization of DILI singularities in this world region, and improvement of Public Health.

Funding

AEMPS, FEDER (PI18/01804). COST Action CA-17112.

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