SIG Greatest Hits: TLM 2025-Pediatric Liver Disorders SIG: Phenotypes of Drug-Induced Liver Injury Overview of Drug-Induced Liver Injury in Children

Pediatric Liver Disorders SIG: Phenotypes of Drug-Induced Liver Injury Overview of Drug-Induced Liver Injury in Children

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Video Transcription

Video Summary

Frank DiPaola, associate professor of pediatrics at the University of Virginia, provides an overview of drug-induced liver injury (DILI) in children. He discusses the classification of DILI into direct, idiosyncratic, and indirect hepatotoxicity, emphasizing the unique pediatric lab reference ranges. Epidemiologically, idiosyncratic DILI is rare, likely less common in children due to lower drug and supplement use, with antibiotics and CNS medications as frequent culprits. Patient-specific factors like genetics and metabolism influence risk; for example, POLG mutations increase valproate toxicity. DILI can cause severe liver injury and acute liver failure in children, with some drugs showing distinctive injury patterns aiding diagnosis and management, such as minocycline-induced autoimmune-like hepatitis and antiepileptic-related DRESS syndrome. Emerging therapies like CFTR modulators (ETI) show liver enzyme elevations, but true DILI is rare and requires careful evaluation. Reintroduction after injury may be possible with monitoring. DiPaola stresses the importance of vigilance, reporting, and research to improve recognition and management of pediatric DILI, especially with new life-changing drugs.

Asset Subtitle

Talk delivered by Dr. Frank DiPaola. This talk was part of the Hepatotoxicity and Pediatric Liver Disorders Special Interest Groups Joint Symposium, Part 1. Drug-Induced Liver Injury: Drug-Induced Liver Injury Across the Lifespan— Advances in Management session.

Keywords

drug-induced liver injury

pediatric hepatotoxicity

idiosyncratic DILI

antibiotics and CNS medications

CFTR modulators liver effects