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The Murine Choline-Deficient, Ethionine-Supplemented CDE Diet Model of Chronic Liver Injury
Published on: October 21, 2017
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Urgent Liver Transplantation for Dietary Supplements: An Under-Recognized Problem
L L Wong1, L Lacar2, M Roytman3
1Department of Surgery, University of Hawaii, John A. Burns School of Medicine, Honolulu, Hawaii.
Transplantation Proceedings
|February 22, 2017
Summary
Herbal and dietary supplements (HDS) are the fourth leading cause of drug-induced acute liver failure requiring liver transplantation (LT). Underreporting suggests HDS may be a more significant cause of liver injury.
Area of Science:
- Hepatology
- Toxicology
- Transplantation Medicine
Background:
- An outbreak of acute liver failure linked to herbal/dietary supplements (HDS) in Hawaii necessitated an investigation.
- Evaluation focused on patients in the United States who underwent emergency liver transplantation (LT) due to HDS-induced liver injury.
Purpose of the Study:
- To evaluate the incidence and characteristics of acute liver failure caused by HDS requiring LT in the US.
- To identify the prevalence of HDS as a cause of drug-induced liver injury (DILI) leading to LT.
Main Methods:
- Utilized the Scientific Registry of Transplant Recipients (SRTR) database from 2003-2015.
- Identified adult patients undergoing urgent LT for acute hepatic necrosis (AHN).
- Characterized cases specifically linked to HDS use.
Main Results:
- Of 2408 adult LT cases, 625 were DILI; HDS accounted for 21 cases (the fourth highest category).
- Specific HDS agents were not listed in 13 of the 21 HDS cases; all occurred post-2007.
- Significant underreporting of HDS as a cause of liver failure was noted (25% of LT cases and 20% of DILI cases lacked specific etiology).
Conclusions:
- HDS represent a significant, though likely underestimated, cause of drug-induced AHN necessitating LT.
- Improved patient and provider questioning regarding HDS use is crucial.
- Enhanced reporting is vital to identify specific HDS products causing liver failure and mitigate risks.
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