Herbal dietary supplements were responsible for what percentage of cases of acute liver failure that led to listing with the United Network for Organ Sharing between 2013 and 2020?
Between 1995 and 2020 investigators using the United Network for Organ Sharing database report that from the time frame 1995-2003 to 2013-2020 the percentage of cases of non-APAP acute liver failure due to a HDS and leading to listing for transplant increased from 2.9% to 24.1%.
Several other recent studies suggest this may not be unique to the United States. A recent study out of Taiwan reported that between 2011 and 2019 HDSs were responsible for for 22% of all non-APAP drug induced liver injury. (Their definition of HDS included raw and processed herbs). A single center study from Australia found that between 2009-2011 and 2018-2020 HDSs accounted for an increasing proportion of cases of non-APAP DILI, from 15% to 47%.
1.Ghabril M, Ma J, Patidar KR, Nephew L, Desai AP, Orman E, Vuppalanchi R, Kubal S, Chalasani N. Eight fold increase in the dietary supplement related liver failure leading to transplant waitlisting over the last quarter century in the US. Liver Transpl. 2021 Jul 31. doi: 10.1002/lt.26246. Online ahead of print.
2.Huang YS, Chang TT, Peng CY, Lo GH, Hsu CW, Hu CT, Huang YH. Herbal and dietary supplement-induced liver injury in Taiwan: comparison with conventional drug-induced liver injury. Hepatol Int. 2021 Aug 11. doi: 10.1007/s12072-021-10241-3. Epub ahead of print. PMID: 34382132
3. Drug-induced liver injury in Australia, 2009-2020: the increasing proportion of non-paracetamol cases linked with herbal and dietary supplements. Nash E, Sabih AH, Chetwood J, Wood G, Pandya K, Yip T, Majumdar A, McCaughan GW, Strasser SI, Liu K. Med J Aust. 2021 Jul 17. doi: 10.5694/mja2.51173. Online ahead of print.
Submitted by: Michael Hodgman, MD on behalf of Herbs & Dietary Supplements Section