Bessone, FernandoBjörnsson, Einar Stefán2025-11-202025-11-202022-07-27Bessone, F & Björnsson, E S 2022, 'Checkpoint inhibitor-induced hepatotoxicity : Role of liver biopsy and management approach', World Journal of Hepatology, vol. 14, no. 7, pp. 1269-1276. https://doi.org/10.4254/wjh.v14.i7.12691948-51827576397817110316-4fba-4316-ac86-8739a3e07c9b36158917PubMedCentral: PMC937677285135257078https://hdl.handle.net/20.500.11815/7076©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.Immunological checkpoint inhibitors (ICIs) have revolutionized therapy of many different malignanices. Concomitant immune-mediated adverse effects are common and can affect many organs such as the skin, lungs, gastrointestinal and endocrine organs as well as the liver. Liver injury has been reported in 3%-8% of patients with grade III-IV hepatitis in retrospective studies. The liver injury is characterized by hepatocellular injury resembling autoimmune hepatitis biochemically but not immunologically as patients with ICI induced hepatoxicity rarely have auto-antibodies or IgG elevation. The role for liver biopsy (LB) in patients with suspected liver injury due to ICIs is controversial and it is not clear whether results of a LB will change clinical management. LB can be helpful when there is diagnostic uncertainty and pre-existing liver disease is suspected. Although there are no distinctive histological features, the finding of granulomas and endothelitis may suggest a specific type of hepatitis induced by ICIs. The natural history of hepatotoxicity of ICI therapy is not well known. Recent studies have demonstrated that 33%-50% of patients improve spontaneously with discontinuation of ICIs. In patients with jaundice and/or coagulopathy corticosteroids are used. The high doses of corticosteroids with 1-2 mg/kg/d of methylprednisolone recommended by the oncological societies are controversial. Recently it has shown that initial treatment with 1 mg/kg/d provided similar liver tests improvement which was also associated with a reduced risk of steroid-induced adverse effects in comparison with higher-dose regimens. Secondary immunosuppression mostly with mycophenolate mofetil has been reported to be helpful.842494021269-1276eninfo:eu-repo/semantics/openAccessSDG 3 - Good Health and Well-being/dk/atira/pure/researchoutput/researchoutputtypes/contributiontojournal/article10.4254/wjh.v14.i7.1269