A systematic survey evaluating 6-thioguanine-related hepatotoxicity in patients with inflammatory bowel disease

Wien Klin Wochenschr. 2007;119(17-18):519-26. doi: 10.1007/s00508-007-0841-0.


Objective: Drug-induced liver injury was recently reported as a major complication leading to hepatic nodular regenerative hyperplasia (NRH) in patients with inflammatory bowel disease (IBD) and 6-thioguanine (6-TG) therapy. The aim of the study was to evaluate the prevalence of 6-TG-related hepatotoxicity in a large multi-centered IBD population by means of a systematic online survey.

Methods: Clinical and laboratory data, imaging techniques (sonography, CT, MRI) and histology of liver biopsies were surveyed in IBD patients treated with 6-TG. The decision on whether liver imaging and/or liver biopsy were performed was exclusively at the discretion of the investigator.

Results: 6-TG use was fully documented in 296 patients (median treatment duration 56 weeks, range < 1-207). Laboratory signs of drug-induced liver injury were found in 43 patients (14.5%). Liver imaging revealed pathologic results in 68/176 patients (38.6%). Liver biopsy was performed in a subset of 60 patients; using silver-reticulin staining (n = 59), NRH was considered in 16 patients (27.1%). Age was the only independent, albeit weak, risk factor for development of NRH.

Conclusion: This large online survey confirms the strong association between 6-TG treatment and the significant risk of development of NRH in patients with IBD. The definitive diagnosis of NRH depends solely upon liver biopsy.

Publication types

  • Comparative Study
  • Evaluation Study
  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Biopsy
  • Child
  • Data Collection
  • Data Interpretation, Statistical
  • Female
  • Focal Nodular Hyperplasia / chemically induced*
  • Focal Nodular Hyperplasia / diagnosis
  • Focal Nodular Hyperplasia / diagnostic imaging
  • Focal Nodular Hyperplasia / pathology
  • Humans
  • Inflammatory Bowel Diseases / drug therapy*
  • Internet
  • Liver / drug effects*
  • Liver / pathology
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Risk Factors
  • Smoking
  • Surveys and Questionnaires
  • Thioguanine / adverse effects*
  • Treatment Outcome
  • Ultrasonography


  • Thioguanine