title: A systematic survey evaluating 6-thioguanine-related hepatotoxicity in patients with inflammatory bowel disease.
abstract: OBJECTIVE
  Drug-induced liver injury was recently reported as a major complication leading to hepatic nodular regenerative hyperplasia (NRH) in patients with inflammatory bowel disease (IBD) and 6-thioguanine (6-TG) therapy. The aim of the study was to evaluate the prevalence of 6-TG-related hepatotoxicity in a large multi-centered IBD population by means of a systematic online survey.
  
  
  METHODS
  Clinical and laboratory data, imaging techniques (sonography, CT, MRI) and histology of liver biopsies were surveyed in IBD patients treated with 6-TG. The decision on whether liver imaging and/or liver biopsy were performed was exclusively at the discretion of the investigator.
  
  
  RESULTS
  6-TG use was fully documented in 296 patients (median treatment duration 56 weeks, range < 1-207). Laboratory signs of drug-induced liver injury were found in 43 patients (14.5%). Liver imaging revealed pathologic results in 68/176 patients (38.6%). Liver biopsy was performed in a subset of 60 patients; using silver-reticulin staining (n = 59), NRH was considered in 16 patients (27.1%). Age was the only independent, albeit weak, risk factor for development of NRH.
  
  
  CONCLUSIONS
  This large online survey confirms the strong association between 6-TG treatment and the significant risk of development of NRH in patients with IBD. The definitive diagnosis of NRH depends solely upon liver biopsy.
authors.affiliation: Medical University of Vienna, Austria.
authors.forename: Alexander
authors.initials: A
authors.lastname: Teml
authors.forename: Matthias
authors.initials: M
authors.lastname: Schwab
authors.forename: Daan W
authors.initials: DW
authors.lastname: Hommes
authors.forename: Sven
authors.initials: S
authors.lastname: Almer
authors.forename: Milan
authors.initials: M
authors.lastname: Lukas
authors.forename: Thomas
authors.initials: T
authors.lastname: Feichtenschlager
authors.forename: Timothy
authors.initials: T
authors.lastname: Florin
authors.forename: Julia
authors.initials: J
authors.lastname: Seiderer
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Petritsch
authors.forename: Bernd
authors.initials: B
authors.lastname: Bokemeyer
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Kreisel
authors.forename: Klaus R
authors.initials: KR
authors.lastname: Herrlinger
authors.forename: Peter
authors.initials: P
authors.lastname: Knoflach
authors.forename: Bruno
authors.initials: B
authors.lastname: Bonaz
authors.forename: Thomas
authors.initials: T
authors.lastname: Klugmann
authors.forename: Hans
authors.initials: H
authors.lastname: Herfarth
authors.forename: Nikolaus
authors.initials: N
authors.lastname: Pedarnig
authors.forename: Walter
authors.initials: W
authors.lastname: Reinisch
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D002648:Child; D003625:Data Collection; D003627:Data Interpretation, Statistical; D005260:Female; D020518:Focal Nodular Hyperplasia / Q000139:chemically induced* / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000188:drug therapy*; D020407:Internet; D008099:Liver / Q000187:drug effects* / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012907:Smoking; D011795:Surveys and Questionnaires; D013866:Thioguanine / Q000009:adverse effects*; D016896:Treatment Outcome; D014463:Ultrasonography
chemical_list: D013866:Thioguanine