Immune-mediated hepatotoxicity (IMH) is not-so-rare complication during treatment with immune checkpoint inhibitors (ICIs). This narrative review aims to report the current knowledge on hepatic immune-related adverse events (irAEs) during immunotherapy from pathogenesis to multidisciplinary management. The majority of cases of IMH are asymptomatic and only a few patients may have clinical conditions. The severity of IMH is usually stratified according to Common Terminology for Clinical Adverse Events (CTCAE) criteria, but these scores may overestimate the clinical severity of IMH compared to the Drug-Induced Liver Injury Network (DILIN) scale. The differential diagnosis of IMH is challenging because the elevated liver enzymes can be due to a number of etiologies such as viral infection, autoimmune and metabolic diseases, liver metastases, biliary diseases, and other drugs. The cornerstones of IMH management are represented by withholding or delaying ICI administration and starting immunosuppressive therapy. A multidisciplinary team, including oncologists, hepatologists, internists, and emergency medicine physicians, is essential for the management of IMH.
免疫介导性肝毒性（IMH）是免疫检查点抑制剂（ICI）治疗过程中并不少见的并发症。本综述旨在从发病机制到多学科管理，系统阐述当前关于免疫治疗期间肝脏免疫相关不良事件（irAE）的认知现状。多数IMH病例并无临床症状，仅少数患者可能出现临床表现。IMH的严重程度通常依据《常见不良事件评价标准》（CTCAE）进行分级，但相较于药物性肝损伤网络（DILIN）分级标准，CTCAE评分可能高估IMH的临床严重程度。由于转氨酶升高可能源于病毒感染、自身免疫性疾病、代谢性疾病、肝转移、胆道疾病及其他药物等多种病因，IMH的鉴别诊断具有挑战性。IMH管理的核心措施包括暂停或延迟ICI给药，并启动免疫抑制治疗。由肿瘤科医师、肝病科医师、内科医师及急诊科医师组成的多学科团队对IMH的管理至关重要。
肿瘤(癌症)患者之家