Histology of amiodarone-induced liver injury revisited: A retrospective morphologic analysis
Recommended Citation
Ahsan BU, Westerhoff M, Yassan L, Xia R, Hart J. Histology of amiodarone-induced liver injury revisited: A retrospective morphologic analysis. Ann Diagn Pathol. 2026;82:152623.
Document Type
Article
Publication Date
6-1-2026
Publication Title
Annals of diagnostic pathology
Keywords
Humans, Amiodarone, Retrospective Studies, Male, Female, Chemical and Drug Induced Liver Injury, Middle Aged, Aged, Cross-Sectional Studies, Anti-Arrhythmia Agents, Liver, Adult, Biopsy, Hepatocytes, Fatty Liver, Cholestasis
Abstract
Amiodarone-induced liver injury (AILI) is a known risk of amiodarone therapy, with presentations ranging from asymptomatic aminotransferase elevations to severe or fatal hepatitis and cirrhosis. Due to limited understanding of its histopathologic features, we conducted a retrospective cross-sectional re-analysis of liver biopsy samples from patients on amiodarone from two centers. Of the 48 liver biopsy samples, 42 (87%) exhibited histologic evidence of AILI. All patients showed minimal or mild macrovesicular steatosis. Ballooned hepatocytes were observed in 36 cases (86%), with 25 (69%) displaying a periportal distribution, 8 (22%) centrilobular, and 3 (8%) panacinar in distribution. Mallory-Denk bodies were found in 36 samples (76%)-18 (50%) were numerous and 18 (50%) multiple. Cholestasis was present in 10 patients, 7 (70%) of whom died. In contrast, 10 (31%) of the 32 patients without cholestasis died. This represents a significantly increased mortality risk for patients with AILI and cholestasis (p = 0.03). While AILI shares features with the more generally known metabolic dysfunction-associated steatotic liver disease, our findings indicate that a prominence of periportal distribution of ballooned hepatocytes and Mallory-Denk bodies despite a minimum of macrovesicular steatosis are characteristic of AILI. Furthermore, cholestasis in biopsy samples may suggest a poorer prognosis in patients on amiodarone.
Medical Subject Headings
Humans; Amiodarone; Retrospective Studies; Male; Female; Chemical and Drug Induced Liver Injury; Middle Aged; Aged; Cross-Sectional Studies; Anti-Arrhythmia Agents; Liver; Adult; Biopsy; Hepatocytes; Fatty Liver; Cholestasis
PubMed ID
41671912
Volume
82
First Page
152623
Last Page
152623
