Drug‐induced liver injury (DILI) is an adverse reaction to many drugs in common use that in a liver transplantation (LT) recipient may cause graft dysfunction and may even lead to graft loss and the need for retransplantation. However, several potential clinical scenarios, such as graft rejection and infection, can confound the diagnosis of suspected DILI in the setting of LT. This makes causal assessment of a new liver injury more uncertain and has traditionally precluded collection of bona fide cases of DILI affecting LT patients in prospective DILI registries and cohorts. Although no studies have yet determined a greater susceptibility of the transplant patient to DILI, these patients nevertheless present certain risk factors that can theoretically increase the risk of DILI. These include the fact that these patients are polymedicated, use drugs that are potentially hepatotoxic, and can have coexisting hepatitis B or C viruses in addition to other factors found in nontransplant patients, such as genetic variants. Therefore, awareness is crucial of any potential hepatotoxic effect of drugs used in the LT recipient and their possible implication in any case of liver dysfunction. In the present article, we review the most common drugs used in LT recipients from a liver safety perspective and address the main pitfalls in attributing causality in this clinical setting. We also affirm the need for further research and collaboration in this somewhat neglected topic in the field of DILI.

中文翻译：

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肝移植后药物引起的肝损伤。

药物诱发的肝损伤（DILI）是对许多常用药物的不良反应，在肝移植（LT）受者中可能导致移植物功能障碍，甚至可能导致移植物损失和重新移植的需要。但是，一些潜在的临床情况，例如移植排斥和感染，可能会使LT背景下可疑DILI的诊断变得混乱。这使得对新肝损伤的因果评估更加不确定，并且传统上排除了在预期的DILI登记处和队列中收集影响LT患者的DILI的真正病例。尽管尚无研究确定移植患者对DILI的敏感性更高，但这些患者仍存在某些危险因素，这些危险因素理论上可​​增加DILI的风险。这些事实包括这些患者是多药的，除了可能在非移植患者中发现的其他因素（例如基因变异）外，还使用可能具有肝毒性的药物，并且可以同时存在乙型或丙型肝炎病毒。因此，对于LT接受者所用药物的任何潜在肝毒性作用及其在任何肝功能异常情况下的潜在意义，认识至关重要。在本文中，我们从肝脏安全的角度回顾了LT受体中最常用的药物，并探讨了在这种临床情况下归因的主要缺陷。我们还确认有必要在DILI领域中这个被忽略的主题上进行进一步的研究和合作。认识对于LT接受者所用药物的任何潜在肝毒性作用及其在任何肝功能异常情况下的潜在意义至关重要。在本文中，我们从肝脏安全的角度审查了LT接受者中最常用的药物，并探讨了在这种临床情况下归因的主要缺陷。我们还确认有必要在DILI领域中这个被忽略的主题上进行进一步的研究和合作。认识对于LT接受者所用药物的任何潜在肝毒性作用及其在任何肝功能异常情况下的潜在意义至关重要。在本文中，我们从肝脏安全的角度审查了LT接受者中最常用的药物，并探讨了在这种临床情况下归因的主要缺陷。我们还确认有必要在DILI领域中这个被忽略的主题上进行进一步的研究和合作。