Editor’s Note: Recently, the “8th International Forum on Drug-Induced Liver Injury (DILI) and the 9th National Academic Conference on Drug-Induced Liver Injury, along with the launch of the ‘2024 Chinese Guidelines for Grassroots Diagnosis and Management of Drug-Induced Liver Injury,'” was successfully held in beautiful Xiamen. This year’s conference focused on the management of liver injury caused by anti-tumor drugs, inviting numerous renowned experts and scholars from home and abroad for rich academic exchanges. Professor Yimin Mao from Renji Hospital, the conference chairman, gave a detailed and in-depth explanation on the conference highlights, international influence, guideline updates, and industry development in a interview with Hepatology Digest.
Highlights, Features, and Overview of the Conference
Professor Yimin Mao: When planning this year’s International Forum and Annual Conference on Drug-Induced Liver Injury, we implemented a series of thoughtful reforms and attempts. These changes were not only reflected in the selection of the conference theme but also in the planning of the content and the innovation of the format.
Firstly, given the increasingly prominent issues of liver injury caused by anti-tumor drugs, especially new targeted and immunotherapies, we decided to use “Management of Liver Injury Induced by Anti-Tumor Drugs” as the theme for this conference and, for the first time, co-hosted it with colleagues in oncology. This decision not only reflects our keen insight into current clinical challenges but also showcases our proactive attitude in addressing these challenges. This conference attracted over a thousand registrants, surpassing previous scales, demonstrating the appeal of this innovative theme.
Secondly, in planning the content, we aimed to balance academic forefront and clinical practice. We invited top scholars from home and abroad to share their research progress in drug-induced liver injury and oncology, while also considering the practical needs of clinical doctors. We designed a series of clinically relevant topics, such as extrahepatic adverse reactions of immune checkpoint inhibitors and drug-induced liver injury accompanied by skin damage, supplemented with real case analyses, enabling clinicians to better understand and apply these research findings.
Additionally, we innovated the format to make more young scholars and doctors the protagonists of the conference. The Youth Forum and Case Competition on the first afternoon provided them with a platform to showcase their talents and communicate. We also invited experts from grassroots medical institutions to share their practical experiences, enriching the conference content and promoting exchanges and cooperation between different levels of medical institutions.
Overall, the planning of this conference reflects our deep understanding and comprehensive consideration of the development of the drug-induced liver injury field. We hope that through these reforms and attempts, we can promote progress and development in the field of drug-induced liver injury, benefiting more doctors.
Promoting International Exchange and Cooperation in the Field of Drug-Induced Liver Injury in China
Professor Yimin Mao: This year, we were honored to invite six top international experts in the field of drug-induced liver injury, whose work and insights are crucial to advancing the field.
Although four experts could not attend in person, they provided wonderful lectures and in-depth discussions online. We are also very grateful to Professor Guruprasad P. Aithal from the University of Nottingham and Professor Victor Navarro from Einstein Medical Center in Philadelphia, who traveled long distances to Xiamen, China, for face-to-face exchanges with us, discussing the latest developments and challenges in the field of drug-induced liver injury.
During a closed-door meeting before the conference, we had extensive exchanges with the two foreign experts on research methods for drug-induced liver injury treatments and literature interpretation, reaching some consensus. This discussion not only enhanced our understanding and cooperation with international experts but also provided valuable ideas and directions for our further research in the field of drug-induced liver injury. Unfortunately, Professor Raul J. Andrade from the University of Malaga in Spain was unable to visit China to discuss research cooperation on drug-induced liver injury due to unforeseen circumstances. We expressed our willingness to cooperate online.
For future international exchanges and cooperation, we have higher expectations. We hope to attract more doctors from the Asia-Pacific region and even Europe and the United States to participate in our conference, jointly promoting international exchanges and cooperation in the field of drug-induced liver injury. We also hope to establish closer cooperative relationships with these top international experts and jointly carry out substantial research projects.
Overall, this conference provided us with a valuable opportunity to exchange and learn from top international experts and laid a solid foundation for our future international exchanges and cooperation. We will continue to work hard to promote the continuous development of international exchanges and cooperation in the field of drug-induced liver injury.
Features and Recommendations of the “2024 Chinese Guidelines for Grassroots Diagnosis and Management of Drug-Induced Liver Injury”
Professor Yimin Mao: There are multiple considerations behind why we decided to formulate the “2024 Chinese Guidelines for Grassroots Diagnosis and Management of Drug-Induced Liver Injury” (hereinafter referred to as the “2024 Grassroots DILI Guidelines”). Firstly, from the initial planning to the official release, we conducted multiple in-depth discussions. The experts involved included top experts from the fields of gastroenterology, hepatology, and infectious diseases, as well as many experienced grassroots practitioners. This is because we understand that while top experts have profound theoretical knowledge, they may not fully comprehend the various challenges and limitations faced by grassroots medical institutions in actual practice. Therefore, we specifically invited many grassroots experts to participate in the writing and discussion of the guidelines to ensure that the guidelines truly reflect the actual situation of grassroots medical institutions.
The 2024 Grassroots DILI Guidelines are based on and guided by the “2023 Chinese Guidelines for Diagnosis and Treatment of Drug-Induced Liver Injury.” While maintaining consistency in core concepts, we adjusted and optimized the expressions to make them more in line with the reading habits and understanding capabilities of grassroots doctors. Considering the diversity and complexity of grassroots medical institutions, we strive to make the guidelines adaptable to various types of grassroots medical institutions and healthcare workers.
In terms of format, we adopted a Q&A format preferred by grassroots doctors to present the guideline content. This format not only allows doctors to quickly find and understand relevant information but also deepens their understanding and application of the guideline content through specific cases and questions. Despite the innovation in format, the core content remains consistent with the 2023 guidelines, ensuring the scientific and authoritative nature of the guidelines.
Finally, we hope that the grassroots version of the DILI guidelines can be truly implemented. Only when the guideline content is widely accepted and applied by grassroots doctors can it maximize its value. We hope that through the promotion and application of this guideline, we can improve the level of diagnosis and treatment of drug-induced liver injury in grassroots medical institutions, providing better, more efficient medical services for patients.
Further Promotion of the 2024 Grassroots DILI Guidelines in Grassroots Institutions
Professor Yimin Mao: After the official release of the 2024 Grassroots DILI Guidelines, we plan to launch a national guideline tour project in the second half of this year and next year. The core goal is to ensure that grassroots medical institutions can truly apply the guideline content in practice, thereby improving the diagnostic and treatment level of drug-induced liver injury in grassroots medical settings.
Given the diversity in equipment, staffing, and patient populations of grassroots medical institutions, we will fully consider the actual situation of each region and grassroots institution during the tour, making appropriate adjustments and customizations to ensure that the tour content closely aligns with local medical practices. We hope that through this approach, grassroots doctors can gain a deeper understanding of the guideline content and translate it into more standardized and effective diagnostic and treatment behaviors.
Drug-induced liver injury cannot be ignored in grassroots medical institutions, primarily because commonly used drugs such as anti-infectives and non-steroidal anti-inflammatory drugs are major causes of liver injury. Additionally, the patient population in grassroots medical institutions has its characteristics, such as a high proportion of elderly patients, multiple comorbidities, and polypharmacy, which increase the risk of drug-induced liver injury. Therefore, through the release and tour of the grassroots guidelines, we hope to raise the awareness and vigilance of grassroots doctors regarding drug-induced liver injury, enabling them to more proactively monitor and detect potential cases, thereby improving patient outcomes.
What I am most concerned about is whether grassroots doctors can truly grasp the essence of the 2024 Grassroots DILI Guidelines and apply them quickly. If the guideline content can be understood by grassroots doctors, I believe they will swiftly incorporate it into their practice. However, if there are barriers to understanding, it indicates that we need to improve our writing and communication of the guidelines. Considering the diversity and complexity of grassroots medical institutions, each region’s starting point and actual situation will vary, naturally affecting their understanding and application of the guidelines. Therefore, we particularly emphasize in-depth exchanges and discussions with grassroots doctors through the guideline tour or similar academic activities to help them better understand and apply the grassroots DILI guidelines, ensuring that the guidelines can be truly implemented and effective.
Prospects for the Field of Drug-Induced Liver Injury
Professor Yimin Mao: In the field of drug-induced liver injury, we face many unmet clinical needs. Diagnostic issues, treatment issues, and identifying biomarkers to predict which patients are more likely to develop drug-induced liver injury, especially severe cases, are current challenges that need urgent solutions. These challenges require not only deep exploration but also more targeted research.
To address these challenges, we need close cooperation with colleagues in the field of gastroenterology and hepatology, as well as interdisciplinary communication with experts in oncology, rheumatology, psychiatry, neurology, tuberculosis, and endocrinology. Because no matter the discipline, they may encounter drug-induced liver injury issues.
We understand that breakthroughs in this field must be supported by high-quality research. Without in-depth research, we cannot truly solve the current problems. Therefore, we look forward to collaborating with colleagues to conduct meaningful research to answer unresolved questions in the field of drug-induced liver injury. With everyone’s joint efforts and cooperation, we believe we can achieve more breakthroughs and progress in this field, bringing better treatment outcomes and quality of life for patients.
