Immune-mediated liver injury induced by PD-1/PD-L1 inhibitors differs from idiosyncratic drug-induced liver injury.

AIM: This study aimed to compare the clinical characteristics, pathology, and outcomes of ILICI and iDILI.

METHODS

In this single-center retrospective study, clinical, laboratory, imaging, pathological, and outcome data from patients diagnosed with ILICI or iDILI were analyzed.

RESULTS

A total of 71 ILICI and 305 iDILI cases were included. Compared with the iDILI cohort, patients with ILICI were older (median age 66.0 vs. 56.0 years, P < 0.001). The ILICI group exhibited longer latency, a higher proportion of cholestatic and mixed liver injury patterns, and less severe biochemical abnormalities, with lower ALT, AST, and total bilirubin levels (P < 0.001). Imaging revealed less frequent signs of hepatic inflammation in ILICI (P < 0.05). Histologically, ILICI appeared to be associated with cholestatic features. Among patients with hepatocellular injury pattern, the cumulative rate of ALT normalization was significantly higher in the ILICI group (HR: 3.677, P < 0.001).

CONCLUSIONS

Our study revealed that, compared with patients with iDILI, the patients with ILICI may present with a higher proportion of the cholestatic biochemical pattern. Furthermore, hepatocellular ILICI showed a trend toward more rapid biochemical recovery compared with hepatocellular iDILI.