Assessment and investigations

  • Review medications: e.g. statins, antibiotics, alcohol history and alternative medicines (herbs)
  • Perform liver screen: – Hepatitis A/B/C serology – Hepatitis E PCR – Anti-ANA/SMA/LKM/SLA/LP/LCI – Iron studies
  • Consider imaging for metastases/portal trombosis

Symptom Grade 1

ALT or AST > ULN – 3x ULN

Bilirubin normal (or unchanged to baseline)


Symptom Grade 2

ALT or AST 3 – 5x ULN

Bilirubin < 3x ULN


Symptom Grade 3

ALT or AST 5 – 20x ULN

Bilirubin > 3x ULN


Symptom Grade 4

ALT or AST > 20x ULN

Bilirubin >10x ULN



ICPi: Immune Checkpoint Blockade Inhibition
ALT: Alanine Transaminase
AST: Aspartate Transaminase
ANA: Anti Nuclear Antibodies
ULN: Upper Limit of Normal
LFT: Liver Function Test
SMA: Smooth Muscle Antibody
LKM: Liver/Kidney Microsome type 1
SLA: Soluble Liver Antigen
LP: Liver/Pancreas
US: Ultra Sound

Note: This is not a diagnosis/management tool for patients: patients should always consult their treating specialist