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Updated: Apr 6, 2026
Human Liver Microphysiological System for Assessing Drug-Induced Liver Toxicity In Vitro
Published on: January 31, 2022
Drug-induced liver injury in children
Mansi D Amin1, Sanjiv Harpavat, Daniel H Leung
1aBaylor College of Medicine bPediatric Gastroenterology, Hepatology and Nutrition, Texas Children's Hospital, Houston, Texas, USA.
Insights
Drug-induced liver injury (DILI) in children is a significant cause of liver failure and transplantation. Genetic factors and mitochondrial dysfunction increase susceptibility, with antibiotics and CNS agents being common culprits.
Area of Science:
- Pediatric Hepatology
- Toxicology
- Pharmacology
Background:
- Drug-induced liver injury (DILI) is a critical cause of pediatric liver disease, contributing to nearly 20% of acute liver failure cases.
- It is a leading indication for liver transplantation in the United States.
- Understanding DILI is crucial for managing pediatric liver health.
Purpose of the Study:
- To review the pathogenesis, diagnosis, and management of DILI in children.
- To highlight recent case series of pediatric DILI.
- To inform clinical practice and future research directions.
Main Methods:
- Literature review of DILI pathogenesis, diagnosis, and management.
- Analysis of recent pediatric DILI case series.
- Synthesis of current knowledge on risk factors and clinical outcomes.
Main Results:
- Individual susceptibility to DILI is influenced by genetic polymorphisms and host factors, affecting 20-25% of drug therapies.
- Children are particularly vulnerable to drug-induced mitochondrial dysfunction, leading to severe liver injury.
- Antibiotics and central nervous system agents are the most frequent causes of DILI in Western pediatric populations, with herbal products increasing.
Conclusions:
- Diagnosing DILI requires excluding other conditions, identifying latency periods, and recognizing risk factors, potentially aided by databases.
- Management focuses on discontinuing the causative agent and providing supportive care.
- Further research is needed to elucidate mechanisms, identify at-risk individuals, and develop targeted therapies.
Purpose Of Review:
Drug-induced liver injury (DILI) is an underrecognized cause of pediatric liver disease, accounts for almost 20% of pediatric acute liver failure cases, and is a major reason for liver transplantation in the USA. This article reviews the pathogenesis of DILI, approach to diagnosis and management, and highlights recent pediatric DILI case series.
Recent Findings:
Select individuals have an increased propensity to develop DILI. Known genetic polymorphisms of enzymes and host factors play an important role in medication management and influence the clinical outcome in 20-25% of all drug therapies. Children are more likely to have mitochondrial dysfunction from drugs, increasing their susceptibility to severe liver injury or acute liver failure. Antibiotics and central nervous system agents account for the majority of pediatric DILI in the West, although herbals are becoming more common.
Summary:
Clinical features of DILI vary and overlap so exclusion of other conditions, identification of latency period and risk factors, and use of a searchable database can aid evaluation. Treatment consists of cessation of the offending agent and supportive care. Areas needing further research include elucidating mechanisms, identifying at risk individuals, and therapeutic interventions.
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