Chinese Hepatolgy ›› 2024, Vol. 29 ›› Issue (8): 965-970.

• Drug-Induced Liver Injury • Previous Articles     Next Articles

Analysis of the influence of bile duct injury of the Clinical and pathological characteristics of immune-mediated liver injury

WANG Yan1, LIU Li-wei2, ZHAO Meng-yu1, CHEN Wei3, ZHAO Xin-yan1   

  1. 1. Liver Research Center, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Diseases,Beijing 100050, China;
    2. Fourth Department of Liver Disease, Beijing You’an Hospital, Capital Medical University, Beijing 100069, China;
    3. Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University,Beijing 100050, China
  • Received:2024-05-16 Online:2024-08-31 Published:2024-09-30
  • Contact: ZHAO Xin-yan, Email: zhao_xinyan@ccmu.edu.cn

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Abstract: Objective To explore the clinical features of immune-mediated liver injury induced by PD-1 inhibitors. Methods A retrospective study including patients with malignancies treated with PD-1 inhibitors and diagnosed with immune mediated liver injury hospitalized in Beijing Friendship Hospital between April 2016 and December 2022 was conducted. Patients were categorized into Common Terminology Criteria for Adverse Events (CTCAE) levels 0, 1, 2 and 3 based on serum alkaline phosphatase (ALP) levels classified according to CTCAE 5.0. A comparative analysis was conducted on the clinical presentations, imaging results, and pathological findings of the aforementioned groups. ANOVA test or non-parametric test was used for continuous variables, the chi-square test for categorical variables, and the Bonferroni correction for multiple comparisons. A significance level of P<0.05 is typically used to determine statistical significance. Results A total of 42 cases of immune-mediated liver injury were included in this study. Based on the ALP grading criteria outlined in CTCAE 5.0, 13 patients were classified as grade 0, 14 as grade 1, 8 as grade 2, and 7 as grade 3. Serum bilirubin levels were significantly elevated in patients classified as CTCAE grade 3 compared to those in grades 0~2 [(24.5 (17.2, 47.1), 25.5 (17.2, 65.5), 21.3 (19.6, 263.8) and 153.0 (43.0, 525.3) μmol/L, respectively P=0.036]. Three patients who underwent abdominal CT or MRI showed alterations in the biliary system, such as thickening and edema of the gallbladder wall, irregular narrowing and dilation of the extrahepatic bile duct. Additionally, two cases received liver biopsy, which revealed bile duct hyperplasia, disorganized arrangement of bile duct epithelium, and interstitial edema within the portal tract. Conclusion Over half of the patients with PD-1 related liver injury may exhibit elevated levels of bile duct enzymes, suggestive of bile duct injury. Part of the patients have imaging changes of bile duct systems. Liver pathology is significant for identifying inflammation and damage to the small bile ducts.

Key words: Immunocheckpoint inhibitors, Immune-mediated cholangiopathy, Alkaline phosphatase, Common Terminology Criteria for Adverse Events 5.0