Liver injury in children with long-term low-dose methotrexate.

Abstract

Long term use of Methotrexate (MTX) can cause liver injury. The aim of this retrospective audit was to correlate clinical and biochemical results with liver histology in children referred to a tertiary Liver unit with suspected MTX induced liver injury and to identify contributing risk factors. Fourteen children with persistently raised transaminases were identified who had 17 liver biopsies. On review of the 14 initial biopsies, 7 had minor changes without fibrosis (Roenigk scale 1 or 2), 6 had at least mild fibrosis, and 1 was cirrhotic. Two of the 3 children with repeat biopsies showed progression. No correlation was identified between the peak and or duration of elevated transaminases with histological findings. Overweight children seemed more likely to have liver injury. This retrospective audit suggests that Children on long term low dose Methotrexate need to be monitored vigilantly, especially in presence of risk factors and liver biopsy is required in a select few to make decisions about treatment. Prospective studies are required to validate non-invasive markers of liver fibrosis so that they can be incorporated in the monitoring guidelines.