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Chronic liver disease patients exhibited sufficient immunologic ability showing relatively similar expression levels of cytokines, chemokines and angiogenic factors in periapical samples compared with the responses from no-chronic liver disease patients. The outcomes of this study suggest that liver impairment did not compromise the periapical immune response.

Studies were conducted to determine the occurrence of liver damage induced by an extract of kava (Piper methysticum) using chronic pre-clinical toxicological tests in rats. Adult male and female Wistar rats were subjected to daily doses of kava extract orally by gavage for 13 weeks. At the end of 13 weeks, the rats were euthanized and blood was collected for laboratory tests. After performing an examination of the thoracic and abdominal cavities, liver resection was performed for macroscopic and histologic examination. Results showed that the P. methysticum extract caused liver lesions in rats and might elicit a toxic effect in humans depending on the dose and period of administration.