Chinese Hepatolgy ›› 2026, Vol. 31 ›› Issue (6): 790-797.

• Frontier, Exploration and Controversy • Previous Articles     Next Articles

The clinical and pathological features of drug-induced liver failure in pediatric and adult liver transplantation recipients

Wei Runjie1, Ma Zikun1, Guo Tiantian1, Meng Yao1, Zhang Mengmeng1, Sun Liying1, Zhu Zhijun2, Zhao Xinyan1   

  1. 1. Liver Research Center, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Diseases, State Key Laboratory of Digestive Health, Beijing 100050, China;
    2. Liver Transplantation Center, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Diseases, State Key Laboratory of Digestive Health, Beijing 100050, China
  • Received:2025-10-23 Online:2026-06-30 Published:2026-07-29
  • Contact: Zhao Xinyan,Email: zhao_xinyan@ccmu.edu.cn

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Abstract: Objective To investigate and compare the clinical and pathological characteristics of drug-induced liver failure (DILF) in pediatric and adult patients undergoing liver transplantation. Methods Nineteen patients diagnosed with DILF who received liver transplantation at our center from February 2013 to December 2024 were retrospectively analyzed. The clinical data including causative drugs, types of liver injuries, laboratory parameters, and pre- and post-transplantation survival of all patients were collected. The pathological features of explanted livers, such as the extent of hepatocyte necrosis and cholestasis, were also assessed. The differences between pediatric and adult groups were systematically compared. Results There were no significant differences between pediatric and adult groups in terms of gender, types of liver injuries, clinical presentations, surgical procedures, or preoperative plasma exchanges. However, the types of causative drugs did differ significantly (P=0.004), with a higher proportion of traditional Chinese medicine had been used in adults (0.00% vs. 72.73%). Pediatric patients had significantly higher alkaline phosphatase (ALP) levels at initial testing[341.00 (312.00, 367.00) vs. 175.00 (147.00, 182.00), P=0.028] and at admission[232.50 (196.75, 327.00) vs. 115.00 (93.00, 143.00), P<0.001], consistent with physiological characteristics. Both the pre-transplant waiting time[16.50 (12.00, 19.25) vs. 27.00 (18.00, 82.00), P=0.047] and post-transplant survival[75.00 (16.25, 361.00) vs. 1 001.00 (448.00, 1430.00), P=0.020] were significantly shorter in patients of the pediatric group. Pathological analysis revealed that children had more severe hepatocyte necrosis and less pronounced bile duct reaction, regeneration, and fibrosis when compared with those adult patients, but these pathological differences did not reach statistical significance. Conclusion Pediatric patients with DILF experience more rapid disease progression, greater severity, and higher mortality risk compared to adults. The underlying pathology is characterized by extensive hepatocyte necrosis with limited regeneration. Early evaluation for liver transplantation should be considered in pediatric DILF patients to prevent adverse outcomes.

Key words: Drug-induced liver injury, Pediatric patients, Drug induced liver failure, Liver pathology, Liver transplantation