{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T14:14:11Z","timestamp":1785248051020,"version":"3.55.0"},"reference-count":64,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T00:00:00Z","timestamp":1781222400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background\/Objectives: Immune checkpoint inhibitors (ICIs) have changed the treatment landscape for several advanced malignancies, but their use is accompanied by immune-related adverse events, including liver injury. Some cases resemble autoimmune hepatitis (AIH), although many are more accurately described as AIH-like immune-mediated hepatitis rather than classical AIH. This distinction matters, as diagnosis is often based on exclusion and management must balance hepatic recovery against interruption of potentially life-prolonging cancer therapy. This systematic review summarised the clinical phenotype, diagnostic assessment, treatment strategies, treatment response, ICI discontinuation, and rechallenge outcomes in patients with ICI-associated AIH-like liver injury. Methods: A systematic PubMed search was performed for English-language human studies reporting autoimmune hepatitis, AIH-like liver injury, or immune-mediated hepatitis following exposure to ICIs. Eligible studies included case reports, case series, retrospective cohorts, prospective cohorts, and pharmacovigilance-type studies with extractable clinical, treatment, or outcome data. Reviews, guidelines, non-original articles, animal studies, non-English publications, and reports without usable liver injury data were excluded. The review followed PRISMA principles. Risk of bias was assessed using Joanna Briggs Institute tools and summarised with ROBVIS. Given the heterogeneity of study design, diagnostic criteria, treatment definitions, and outcome reporting, formal meta-analysis was not appropriate; results were therefore synthesised descriptively. Results: Twenty-two studies were included, comprising 195 patients with ICI-associated AIH-like or immune-mediated hepatitis. Of these, 140 patients received active treatment, and 133\/140 achieved clinical or biochemical recovery with varying therapies. Corticosteroids were the most frequently used first-line therapy, with recovery reported in 102\/105 patients treated with corticosteroids alone. Mycophenolate mofetil was the main second-line agent for steroid-refractory disease, with response reported in 9\/10 treated patients. Other therapies, including tacrolimus, azathioprine, ursodeoxycholic acid, bezafibrate, tocilizumab, basiliximab, infliximab, budesonide, and double plasma molecular adsorption system with or without plasma exchange, were described only in small numbers or isolated cases. Spontaneous recovery without pharmacological treatment was reported in 19 patients. ICI interruption or discontinuation occurred in 141 patients, and rechallenge was reported in 55 patients after recovery, with no recurrent hepatic toxicity documented in the extracted dataset. Conclusions: ICI-associated AIH-like liver injury is an important immune-related toxicity, but the available literature remains fragmented and methodologically heterogeneous. Most reported patients recovered, particularly with corticosteroids, and MMF appears to be the most consistently used escalation therapy in steroid-refractory cases. However, the strength of evidence is limited by uncontrolled designs, variable terminology, inconsistent diagnostic work-up, and non-standardised outcome definitions. Future studies should separate classical AIH from AIH-like immune-mediated hepatitis, use uniform criteria for severity and response, and report treatment denominators clearly, especially for rechallenge and steroid-refractory disease.<\/jats:p>","DOI":"10.3390\/diagnostics16121821","type":"journal-article","created":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T00:44:58Z","timestamp":1781484298000},"page":"1821","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Autoimmune Hepatitis Induced by Immune Checkpoint Inhibitors in Adults: A Systematic Review"],"prefix":"10.3390","volume":"16","author":[{"given":"Sarita","family":"Chonat","sequence":"first","affiliation":[{"name":"Acute Medicine, University of South Wales in Association with Learna Ltd., Cardiff CF37 1DL, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6055-4783","authenticated-orcid":false,"given":"Jonathan","family":"Soldera","sequence":"additional","affiliation":[{"name":"Gastroenterology and Acute Medicine, University of South Wales in Association with Learna Ltd., Cardiff CF37 1DL, UK"},{"name":"Logan Hospital, Brisbane, QLD 4131, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2173","DOI":"10.3390\/curroncol28030201","article-title":"Real World Outcomes and Hepatotoxicity of Infliximab in the Treatment of Steroid-Refractory Immune-Related Adverse Events","volume":"28","author":"Araujo","year":"2021","journal-title":"Curr. Oncol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"S2481","DOI":"10.14309\/01.ajg.0000965188.32051.39","article-title":"S3887Recognition of Delayed-Onset Immune Checkpoint Inhibitor-Mediated Hepatotoxicity Treated with Budesonide: A Case Study Factoring in Pharmacokinetics of Immunotherapies","volume":"118","author":"Chopra","year":"2023","journal-title":"Am. J. Gastroenterol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e005635","DOI":"10.1136\/jitc-2022-005635","article-title":"Systematic comparison with autoimmune liver disease identifies specific histological features of immune checkpoint inhibitor-related adverse events","volume":"10","author":"Coukos","year":"2022","journal-title":"J. Immunother. Cancer"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1181","DOI":"10.1016\/j.jhep.2018.01.033","article-title":"Characterization of liver injury induced by cancer immunotherapy using immune checkpoint inhibitors","volume":"68","author":"Michot","year":"2018","journal-title":"J. Hepatol."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Feng, Y., Li, C., Ji, Y., Liu, Y., Gan, L., Yu, Y., and Liu, T. (2022). Nivolumab Combined with Ipilimumab Treatment Induced Hypophysitis and Immune-Mediated Liver Injury in Advanced Esophageal Squamous Cell Carcinoma: A Case Report. Front. Oncol., 12.","DOI":"10.3389\/fonc.2022.801924"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1847","DOI":"10.2169\/internalmedicine.6535-20","article-title":"Rapid Progression of Liver Fibrosis Induced by Acute Liver Injury Due to Immune-related Adverse Events of Atezolizumab","volume":"60","author":"Honma","year":"2021","journal-title":"Intern. Med."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Li, X., Ji, L., Li, X., Sun, D., and Yang, W. (2022). Application of artificial liver in immune-related liver injury induced by immune checkpoint inhibitor: Case reports and review of the literature. Front. Immunol., 13.","DOI":"10.3389\/fimmu.2022.1001823"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Kocheise, L., Piseddu, I., Vonderlin, J., Tjwa, E.T., Buescher, G., Meunier, L., Goeggelmann, P., Fianchi, F., Dumortier, J., and Riveiro Barciela, M. (2023). PD-1\/PD-L1 immune checkpoint therapy demonstrates favorable safety profile in patients with autoimmune and cholestatic liver disease. Front. Immunol., 14.","DOI":"10.3389\/fimmu.2023.1326078"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1759","DOI":"10.1016\/j.jtho.2021.06.024","article-title":"Beyond Steroids: Immunosuppressants in Steroid-Refractory or Resistant Immune-Related Adverse Events","volume":"16","author":"Luo","year":"2021","journal-title":"J. Thorac. Oncol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"647","DOI":"10.1007\/s00432-021-03870-6","article-title":"Presence of autoantibodies in serum does not impact the occurrence of immune checkpoint inhibitor-induced hepatitis in a prospective cohort of cancer patients","volume":"148","author":"Purde","year":"2022","journal-title":"J. Cancer Res. Clin. Oncol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"230","DOI":"10.1186\/s13256-020-02541-3","article-title":"Ursodeoxycholic acid and bezafibrate were useful for steroid-refractory, immune-related hepatitis: A case report","volume":"14","author":"Onishi","year":"2020","journal-title":"J. Med. Case Rep."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"849","DOI":"10.1634\/theoncologist.2017-0531","article-title":"Delayed Autoimmune Toxicity Occurring Several Months After Cessation of Anti-PD-1 Therapy","volume":"23","author":"Parakh","year":"2018","journal-title":"Oncologist"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"732","DOI":"10.1016\/j.cgh.2022.03.050","article-title":"Retreatment With Immune Checkpoint Inhibitors After a Severe Immune-Related Hepatitis: Results From a Prospective Multicenter Study","volume":"21","author":"Salcedo","year":"2023","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_14","first-page":"261","article-title":"Gastrointestinal and liver immune-related adverse effects induced by immune checkpoint inhibitors: A descriptive observational study","volume":"44","year":"2021","journal-title":"Gastroenterol. Hepatol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1186\/s40425-019-0727-5","article-title":"Unchecked immunity: A unique case of sequential immune-related adverse events with Pembrolizumab","volume":"7","author":"Shah","year":"2019","journal-title":"J. Immunother. Cancer"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"4415","DOI":"10.12998\/wjcc.v9.i17.4415","article-title":"Efficacy of artificial liver support system in severe immune-associated hepatitis caused by camrelizumab: A case report and review of the literature","volume":"9","author":"Tan","year":"2021","journal-title":"World J. Clin. Cases"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1747","DOI":"10.1007\/s00432-020-03448-8","article-title":"Clinical features of immune-mediated hepatotoxicity induced by immune checkpoint inhibitors in patients with cancers","volume":"147","author":"Yamamoto","year":"2021","journal-title":"J. Cancer Res. Clin. Oncol."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Zarrabi, M., Hamilton, C., French, S.W., Federman, N., and Nowicki, T.S. (2023). Successful treatment of severe immune checkpoint inhibitor associated autoimmune hepatitis with basiliximab: A case report. Front. Immunol., 14.","DOI":"10.3389\/fimmu.2023.1156746"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"965","DOI":"10.1038\/s41379-018-0013-y","article-title":"Hepatotoxicity of immune checkpoint inhibitors: A histology study of seven cases in comparison with autoimmune hepatitis and idiosyncratic drug-induced liver injury","volume":"31","author":"Zen","year":"2018","journal-title":"Mod. Pathol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1770","DOI":"10.1007\/s12072-024-10688-0","article-title":"Management and treatment of severe immune-related hepatotoxicity based on clinical and pathological characteristics","volume":"18","author":"Zhang","year":"2024","journal-title":"Hepatol. Int."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e001322","DOI":"10.1136\/jitc-2020-001322","article-title":"When steroids are not enough in immune-related hepatitis: Current clinical challenges discussed on the basis of a case report","volume":"8","author":"Ziogas","year":"2020","journal-title":"J. Immunother. Cancer"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Macek Jilkova, Z., Hilleret, M.N., Gerster, T., Sturm, N., Mercey-Ressejac, M., Zarski, J.P., Leroy, V., Marche, P.N., Costentin, C., and Decaens, T. (2021). Increased Intrahepatic Expression of Immune Checkpoint Molecules in Autoimmune Liver Disease. Cells, 10.","DOI":"10.3390\/cells10102671"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1053\/jhep.2002.30991","article-title":"Current and novel immunosuppressive therapy for autoimmune hepatitis","volume":"35","author":"Heneghan","year":"2002","journal-title":"Hepatology"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1634\/theoncologist.2018-0162","article-title":"Workup and Management of Immune-Mediated Hepatobiliary Pancreatic Toxicities That Develop During Immune Checkpoint Inhibitor Treatment","volume":"25","author":"Hsu","year":"2020","journal-title":"Oncologist"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"719","DOI":"10.1111\/hepr.14078","article-title":"Diagnostic guide for immune checkpoint inhibitor-induced liver injury","volume":"54","author":"Ito","year":"2024","journal-title":"Hepatol. Res."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Lasagna, A., and Sacchi, P. (2024). The ABC of Immune-Mediated Hepatitis during Immunotherapy in Patients with Cancer: From Pathogenesis to Multidisciplinary Management. Cancers, 16.","DOI":"10.3390\/cancers16040795"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1002\/hep.32215","article-title":"Effect of corticosteroid dosing on outcomes in high-grade immune checkpoint inhibitor hepatitis","volume":"75","author":"Li","year":"2022","journal-title":"Hepatology"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Liu, Z., Zhu, Y., Xie, H., and Zou, Z. (2022). Immune-mediated hepatitis induced by immune checkpoint inhibitors: Current updates and future perspectives. Front. Pharmacol., 13.","DOI":"10.3389\/fphar.2022.1077468"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"100704","DOI":"10.1016\/j.iotech.2024.100704","article-title":"Updates in the pathogenesis and management of immune-related enterocolitis, hepatitis and cardiovascular toxicities","volume":"21","author":"McKenzie","year":"2024","journal-title":"Immunooncol. Technol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1016\/j.ejca.2015.11.016","article-title":"Immune-related adverse events with immune checkpoint blockade: A comprehensive review","volume":"54","author":"Michot","year":"2016","journal-title":"Eur. J. Cancer"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"102514","DOI":"10.1016\/j.jaut.2020.102514","article-title":"Best practices for detection, assessment and management of suspected immune-mediated liver injury caused by immune checkpoint inhibitors during drug development","volume":"114","author":"Regev","year":"2020","journal-title":"J. Autoimmun."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"3044","DOI":"10.3390\/curroncol29050247","article-title":"Immune Checkpoint Inhibitors in Cancer Therapy","volume":"29","author":"Shiravand","year":"2022","journal-title":"Curr. Oncol."},{"key":"ref_33","first-page":"83","article-title":"Immune Checkpoint Inhibitor-Induced Hepatic Injury: A Clinicopathologic Review","volume":"2","author":"Taherian","year":"2022","journal-title":"J. Clin. Transl. Pathol."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Affolter, T., Llewellyn, H.P., Bartlett, D.W., Zong, Q., Xia, S., Torti, V., and Ji, C. (2019). Inhibition of immune checkpoints PD-1, CTLA-4, and IDO1 coordinately induces immune-mediated liver injury in mice. PLoS ONE, 14.","DOI":"10.1371\/journal.pone.0217276"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"FSO614","DOI":"10.2144\/fsoa-2020-0056","article-title":"Steroid-refractory immune related hepatitis may hide viral re-activation","volume":"6","author":"Citarella","year":"2020","journal-title":"Future Sci. OA"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"426","DOI":"10.1038\/s41379-020-00653-1","article-title":"Liver biopsy findings in patients on immune checkpoint inhibitors","volume":"34","author":"Cohen","year":"2021","journal-title":"Mod. Pathol."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Delire, B., De Martin, E., Meunier, L., Larrey, D., and Horsmans, Y. (2021). Immunotherapy and Gene Therapy: New Challenges in the Diagnosis and Management of Drug-Induced Liver Injury. Front. Pharmacol., 12.","DOI":"10.3389\/fphar.2021.786174"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"9242","DOI":"10.1038\/s41598-021-88824-1","article-title":"Clinicopathological analysis of hepatic immune-related adverse events in comparison with autoimmune hepatitis and graft-versus host disease","volume":"11","author":"Hagiwara","year":"2021","journal-title":"Sci. Rep."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Hercun, J., Vincent, C., Bilodeau, M., and Lapierre, P. (2022). Immune-Mediated Hepatitis During Immune Checkpoint Inhibitor cancer Immunotherapy: Lessons From Autoimmune Hepatitis and Liver Immunology. Front. Immunol., 13.","DOI":"10.3389\/fimmu.2022.907591"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1080\/17425255.2019.1574744","article-title":"Hepatotoxicity induced by immune checkpoint inhibitors: A comprehensive review including current and alternative management strategies","volume":"15","author":"Jennings","year":"2019","journal-title":"Expert Opin. Drug Metab. Toxicol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"364","DOI":"10.1055\/s-0029-1240005","article-title":"The pathology of drug-induced liver injury","volume":"29","author":"Kleiner","year":"2009","journal-title":"Semin. Liver Dis."},{"key":"ref_42","first-page":"101773","article-title":"Immune checkpoint inhibitor (ICI)-induced hepatitis diagnosed by liver biopsy followed by ICI-free chemotherapy leading to therapeutic effect: A case of lung cancer treatment","volume":"40","author":"Okuno","year":"2022","journal-title":"Respir. Med. Case Rep."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1396","DOI":"10.1016\/j.jhep.2018.08.014","article-title":"Incidence of grade 3-4 liver injury under immune checkpoints inhibitors: A retrospective study","volume":"69","author":"Parlati","year":"2018","journal-title":"J. Hepatol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1002\/hep.31227","article-title":"Hepatotoxicity From Immune Checkpoint Inhibitors: A Systematic Review and Management Recommendation","volume":"72","author":"Peeraphatdit","year":"2020","journal-title":"Hepatology"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"991","DOI":"10.1634\/theoncologist.2018-0174","article-title":"Diagnosis and Management of Hepatitis in Patients on Checkpoint Blockade","volume":"23","author":"Reynolds","year":"2018","journal-title":"Oncologist"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1018","DOI":"10.1002\/ijc.30678","article-title":"Risk of hepatotoxicity in cancer patients treated with immune checkpoint inhibitors: A systematic review and meta-analysis of published data","volume":"141","author":"Wang","year":"2017","journal-title":"Int. J. Cancer"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"101619","DOI":"10.1016\/j.tranon.2023.101619","article-title":"The Current status of steroid-refractory immune-checkpoint-inhibitor-related hepatotoxicity","volume":"28","author":"Xing","year":"2023","journal-title":"Transl. Oncol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1016\/j.pathol.2025.10.010","article-title":"The spectrum of clinical and histopathological features in patients undergoing liver biopsy for immune-checkpoint-inhibitor-associated hepatotoxicity: A 10-year multicentre experience","volume":"58","author":"Boon","year":"2026","journal-title":"Pathology"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"434","DOI":"10.1053\/j.semdp.2019.07.009","article-title":"Checkpoint inhibitor-induced liver injury: A novel form of liver disease emerging in the era of cancer immunotherapy","volume":"36","author":"Zen","year":"2019","journal-title":"Semin. Diagn. Pathol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1217","DOI":"10.1016\/j.annonc.2022.10.001","article-title":"Management of toxicities from immunotherapy: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up","volume":"33","author":"Haanen","year":"2022","journal-title":"Ann. Oncol."},{"key":"ref_51","first-page":"106","article-title":"Immune-mediated hepatitis: Basic concepts and treatment","volume":"89","author":"Crespo","year":"2024","journal-title":"Rev. Gastroenterol. Mex. (Engl. Ed.)"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"387","DOI":"10.6004\/jnccn.2022.0020","article-title":"Management of Immunotherapy-Related Toxicities, Version 1.2022, NCCN Clinical Practice Guidelines in Oncology","volume":"20","author":"Thompson","year":"2022","journal-title":"J. Natl. Compr. Cancer Netw."},{"key":"ref_53","unstructured":"U.S. Department of Health and Human Services (2025, January 20). Common Terminology Criteria for Adverse Events (CTCAE) Common Terminology Criteria for Adverse Events (CTCAE) v5.0, Available online: https:\/\/ctep.cancer.gov\/protocoldevelopment\/electronic_applications\/docs\/CTCAE_v5_Quick_Reference_5x7.pdf."},{"key":"ref_54","doi-asserted-by":"crossref","unstructured":"Liu, C., Yang, M., Zhang, D., Chen, M., and Zhu, D. (2022). Clinical cancer immunotherapy: Current progress and prospects. Front. Immunol., 13.","DOI":"10.3389\/fimmu.2022.961805"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"2235","DOI":"10.1007\/s00432-022-04340-3","article-title":"Immune checkpoint inhibitor-induced hepatitis injury: Risk factors, outcomes, and impact on survival","volume":"149","author":"Miah","year":"2023","journal-title":"J. Cancer Res. Clin. Oncol."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1097\/COC.0000000000000239","article-title":"CTLA-4 and PD-1 Pathways: Similarities, Differences, and Implications of Their Inhibition","volume":"39","author":"Buchbinder","year":"2016","journal-title":"Am. J. Clin. Oncol."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"2109","DOI":"10.1002\/hep.27254","article-title":"Immune tolerance in liver disease","volume":"60","author":"Crispe","year":"2014","journal-title":"Hepatology"},{"key":"ref_58","doi-asserted-by":"crossref","unstructured":"Gudd, C.L.C., and Possamai, L.A. (2022). The Role of Myeloid Cells in Hepatotoxicity Related to Cancer Immunotherapy. Cancers, 14.","DOI":"10.3390\/cancers14081913"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"898","DOI":"10.3390\/curroncol28010088","article-title":"Very Delayed Acute Hepatitis after Pembrolizumab Therapy for Advanced Malignancy: How Long Should We Watch?","volume":"28","author":"Phan","year":"2021","journal-title":"Curr. Oncol."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"101481","DOI":"10.4291\/wjgp.v16.i1.101481","article-title":"Evaluation of biological therapies in autoimmune hepatitis: A case-based systematic review","volume":"16","author":"Eldew","year":"2025","journal-title":"World J. Gastrointest. Pathophysiol."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"5490","DOI":"10.12998\/wjcc.v9.i20.5490","article-title":"Herb-induced liver injury: Systematic review and meta-analysis","volume":"9","author":"Ballotin","year":"2021","journal-title":"World J. Clin. Cases"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref_63","doi-asserted-by":"crossref","unstructured":"Soldera, J. (2026). Beyond the Tipping Point: Advances in the Diagnosis and Management of Acute-on-Chronic Liver Failure and End-Stage Liver Disease. Diagnostics, 16.","DOI":"10.3390\/diagnostics16101548"},{"key":"ref_64","doi-asserted-by":"crossref","unstructured":"P\u0103dureanu, V., R\u0103dulescu, V.M., Moise, C.G., Marina\u0219, M.C., P\u0103dureanu, R., S\u0103biescu, D.M., P\u00eer\u0219coveanu, D.F.V., For\u021bofoiu, D., and Boldeanu, L. (2025). Clinical Evaluation of Oxidative Stress Biomarkers in Cirrhosis: Associations with Child-Pugh Class and Hepatic Encephalopathy. Diagnostics, 15.","DOI":"10.3390\/diagnostics15222853"}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/12\/1821\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T01:06:38Z","timestamp":1781485598000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/12\/1821"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,12]]},"references-count":64,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["diagnostics16121821"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics16121821","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,12]]}}}