{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:08:16Z","timestamp":1792786096200,"version":"4.5.0"},"reference-count":21,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T00:00:00Z","timestamp":1779148800000},"content-version":"am","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"name":"Manchester Academic Health Science Centre","id":[{"id":"https:\/\/ror.org\/04rrkhs81","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Liver toxicity is common in patients treated with immune checkpoint inhibitor (ICI) therapy. Most guidelines advocate for the admission of patients with grade 3\/4 ICI-mediated hepatitis. Ambulatory emergency care forms a fundamental part of the strategy of trying to ensure safe and sustainable acute care services.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>An ambulatory pathway for ICI-mediated hepatitis (CTCAE grade 3\/4) was commenced in March 2023. Patients with ICI-mediated hepatitis with normal synthetic liver function (bilirubin &amp;lt;30\u00b5mol\/l, INR &amp;lt;1.5, albumin &amp;gt;30\u2009g\/l and grade \u22642 encephalopathy) were considered as potential candidates for acute ambulatory management. Patients received either ambulatory intravenous methylprednisolone 1\u2009mg\/kg for 2\u20133\u2009days or 1\u2009mg\/kg oral prednisolone. The primary outcome measure was 30-day readmission due to progressive\/refractory hepatitis. Secondary outcome measures were the decision to rechallenge with ICI therapy and 30-day all-cause mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Eighty-nine patients treated with ICI therapy presented with grade \u2265 3 transaminase rises during the study period. Thirty-eight patients were diagnosed with ICI-mediated hepatitis, of whom 23 (59%) patients were managed on the ambulatory pathway. Ambulatory pathway patients had a median age of 62\u2009years (37\u201378), and 10 (43.5%) were male. Median ALT was 323\u2009\u03bc\/l (range 10\u201349\u2009\u03bc\/l) and AST 302\u2009\u03bc\/l (range 0\u201333\u2009\u03bc\/l). No patients required admission due to failure of ambulatory management or worsening liver function. No patients died of any cause within 30\u2009days.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Our ambulatory care pathway has been utilized successfully to treat patients with severe ICI-mediated hepatitis. There were no observable adverse outcomes including readmissions and deaths. The adoption of this pathway for appropriate patients could potentially lead to a reduction in hospital admissions, reducing the financial burden of toxicity care, improving patient outcomes and enhancing patient experience.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/qjmed\/hcag130","type":"journal-article","created":{"date-parts":[[2026,5,17]],"date-time":"2026-05-17T11:31:59Z","timestamp":1779017519000},"source":"Crossref","is-referenced-by-count":1,"title":["Hepatitis at home: ambulatory management of severe immune checkpoint inhibitor-related hepatitis"],"prefix":"10.1093","author":[{"given":"Tim","family":"Cooksley","sequence":"first","affiliation":[{"name":"Department of Acute Oncology, The Christie , Manchester,","place":["UK"]},{"name":"University of Greater Manchester , Bolton, Lancashire,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jamie M J","family":"Weaver","sequence":"additional","affiliation":[{"name":"Department of Acute Oncology, The Christie , Manchester,","place":["UK"]},{"name":"University of Manchester , Manchester,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Safwaan","family":"Adam","sequence":"additional","affiliation":[{"name":"Department of Acute Oncology, The Christie , Manchester,","place":["UK"]},{"name":"University of Manchester , Manchester,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tommaso","family":"Bosetti","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, The Christie , Manchester,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Knight","sequence":"additional","affiliation":[{"name":"University of Manchester , Manchester,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Lasserson","sequence":"additional","affiliation":[{"name":"University of Warwick , Coventry,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca","family":"Lee","sequence":"additional","affiliation":[{"name":"University of Manchester , Manchester,","place":["UK"]},{"name":"Department of Medical Oncology, The Christie , Manchester,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Lorigan","sequence":"additional","affiliation":[{"name":"University of Manchester , Manchester,","place":["UK"]},{"name":"Department of Medical Oncology, The Christie , Manchester,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,5,19]]},"reference":[{"key":"2026092819562134600_hcag130-B1","doi-asserted-by":"crossref","first-page":"100851","DOI":"10.1016\/j.jhepr.2023.100851","article-title":"Incidence, risk factors and outcomes of checkpoint inhibitor-induced liver injury: a 10-year real-world retrospective cohort 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