Kumar R, Kumar A, Kumar S. Acute liver failure from anti-tuberculosis drug-induced liver injury: An update. World J Hepatol 2025; 17(5): 106618 [DOI: 10.4254/wjh.v17.i5.106618]
Corresponding Author of This Article
Ramesh Kumar, MD, Department of Gastroenterology, All India Institute of Medical Sciences, Phulwari Sharif, Patna 801507, India. docrameshkr@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Hepatol. May 27, 2025; 17(5): 106618 Published online May 27, 2025. doi: 10.4254/wjh.v17.i5.106618
Acute liver failure from anti-tuberculosis drug-induced liver injury: An update
Ramesh Kumar, Abhishek Kumar, Sudhir Kumar
Ramesh Kumar, Abhishek Kumar, Sudhir Kumar, Department of Gastroenterology, All India Institute of Medical Sciences, Patna 801507, India
Author contributions: Kumar R and Kumar A designed the concept, collected the data and wrote the manuscript; Kumar S collected the data and wrote the manuscript; all authors have read and approved the final manuscript.
Conflict-of-interest statement: None of authors have any conflict of interest related to this work.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ramesh Kumar, MD, Department of Gastroenterology, All India Institute of Medical Sciences, Phulwari Sharif, Patna 801507, India. docrameshkr@gmail.com
Received: March 4, 2025 Revised: April 1, 2025 Accepted: May 10, 2025 Published online: May 27, 2025 Processing time: 85 Days and 20.1 Hours
Abstract
Tuberculosis (TB) is still a major public health issue in developing countries, where it causes a heavy disease burden. Although current anti-TB treatment regimens demonstrate high efficacy, the hepatotoxic potential of first-line anti-TB drugs (ATDs) - particularly isoniazid, rifampicin, and pyrazinamide—poses a considerable risk, as these agents are associated with a significant incidence of ATD-induced liver injury (AT-DILI). The clinical presentation of AT-DILI can range from asymptomatic elevations in serum transaminases, which may resolve spontaneously due to hepatic adaptation, to acute liver failure (ALF), a potentially life-threatening condition. A recent meta-analysis reported a global incidence of AT-DILI of 11.5%, with rates varying from 2% to 28%. Approximately 7% of patients with AT-DILI progress to ALF, a condition characterized by a poor survival rate with medical therapy. ATD-induced ALF (AT-ALF) is clinically indistinguishable from ALF due to other causes and disproportionately affects young female patients, typically within eight weeks of treatment initiation. Emergency liver transplantation has become an effective therapeutic option for AT-ALF, although outcomes are generally poorer compared to elective transplantation. This minireview provides a comprehensive overview of AT-ALF, covering its epidemiology, risk factors, clinical presentation, prognosis, and treatment options.
Core Tip: Tuberculosis (TB) remains a significant public health concern in developing countries. First-line anti-TB drugs (ATDs) pose a risk of drug-induced liver injury (DILI), which can progress to acute liver failure (ALF), a life-threatening condition. The global incidence of ATD-induced DILI is approximately 11.5%, with around 7% of cases progressing to ALF within two months of treatment initiation. Notably, young female patients are disproportionately affected by this condition, which is clinically indistinguishable from other causes of ALF and is associated with a high mortality rate, necessitating emergency liver transplantation. This minireview provides a comprehensive overview of ATD-induced ALF, covering epidemiology, risk factors, and treatment options.
