- Suspend ICPI
- If bilirubin < 3ULN: oral prednisolone 1 mg/kg
-If bilirubin > 3ULN or one of the following hypoglycaemia, increasing bilirubin, lowering INR or albumin: admit patient treat intravenously: i.v. (methyl)prednisolone 2 mg/kg

- Daily LFTs/INR/albumin
- Perform US with Doppler with liver biopsy if no bleeding diasthesis (should be discussed with specialised anatomopathologist)
- If refractory after 3 days to corticoids or bleeding diasthesis: consult hepatologist


Worsening despite steroids:
- If on oral change to i.v. (methyl)prednisolone
- If on i.v. add MMF 500-1000 mg b.d. after discussion with hepatologist

Steroid wean:
- G2: once G1, wean over 2 weeks; re-escalate if worsening; treatment may be resumed once prednisolone < 10 mg
- G3/4: once improved to G2, can change to oral prednisolone and wean over 4 weeks
- Only resume ICPI if steroids are fully tapered; ideally this is discussed at a multidisciplinary meeting