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While some types of DILI are mild and resolve quickly after removing the drug, other situations are more complex, with competing aetiologies or underlying liver disease. Guidelines from professional societies agree that the liver biopsy retains a role in understanding and managing DILI in certain situations. Liver biopsy allows characterization of the histological pattern of injury as well as assessment of severity. Inflammatory infiltrates, bile duct injury or loss and vascular injury are all revealed by liver biopsy. Communication between the hepatopathologist and clinical team with clinicopathological correlation of the findings is necessary for the best determination of causality and differentiation from other diseases of exclusion, like autoimmune hepatitis and graft\u2010versus\u2010host disease. This review highlights important aspects of the role of liver biopsy in DILI evaluation.<\/jats:p>","DOI":"10.1111\/liv.16097","type":"journal-article","created":{"date-parts":[[2024,9,10]],"date-time":"2024-09-10T08:09:38Z","timestamp":1725955778000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Role of liver biopsy in the management of idiosyncratic\n                    <scp>DILI<\/scp>"],"prefix":"10.1111","volume":"45","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3442-4453","authenticated-orcid":false,"given":"David E.","family":"Kleiner","sequence":"first","affiliation":[{"name":"Chief Post\u2010Mortem Section, Laboratory of Pathology National Cancer Institute  Bethesda Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,9,10]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12072-021-10144-3"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2019.02.014"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.32689"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12072-023-10633-7"},{"issue":"3","key":"e_1_2_7_6_1","first-page":"192","article-title":"Histopathologic changes associated with fialuridine hepatotoxicity","volume":"10","author":"Kleiner DE","year":"1997","journal-title":"Mod Pathol"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199510263331702"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.93.8.3592"},{"key":"e_1_2_7_9_1","unstructured":"FDA Guidance for Industry.Drug\u2010Induced Liver Injury: Pre\u2010Marketing Clinical Evaluation.2009.https:\/\/www.fda.gov\/media\/116737\/downloadAccessed October 20 2012."},{"key":"e_1_2_7_10_1","unstructured":"European Medicines Agency.Reflection Paper on Non\u2010clinical Evaluation of Drug\u2010Induced Liver Injury (DILI).https:\/\/www.ema.europa.eu\/en\/documents\/scientific\u2010guideline\/reflection\u2010paper\u2010non\u2010clinical\u2010evaluation\u2010drug\u2010induced\u2010liver\u2010injury\u2010dili_en.pdf. 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