[The influence of liver dysfunction before transplantation and during conditioning period on the outcome of allogeneic hematopoietic stem cell transplantation].

Abstract

OBJECTIVE:

To investigate the characteristics of liver dysfunction pre-transplant and during conditioning period and its impacts on transplantation related hepatic complication, overall survival (OS) and transplant-related mortality (TRM).

METHODS:

A total of 196 patients undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT) at Peking University First Hospital were analyzed retrospectively. Liver function test for each patient was examined pre-transplant and during the period of conditioning. The correlation of liver dysfunction with hepatic complications, OS and TRM rates were analyzed.

RESULTS:

Liver dysfunction before transplantation was found in 38 (19.8%, 38/192) patients, while damage of liver function during conditioning was found in 159(81.1%) patients, 28 of whom developed grade 3 hepatic dysfunction. There was no life-threatening impairment of liver function. No matter pre-transplant or during conditioning, liver dysfunction did not suggest apparent influence on the engraftment of neutrophil or platelet or the incidence of hepatic complications including hepatic veno occlusive disease (HVOD), acute graft versus host disease (aGVHD) and chronic graft versus host disease (cGVHD). Univariate analysis revealed that factors affecting OS rate included age (P = 0.022), high risk stage (P = 0.003), AST and TBil elevation before transplantation (P = 0.019 and 0.015 respectively), III-IV hepatic aGVHD (P = 0.000) and HVOD(P = 0.000). Multivariate Cox regression analysis revealed that high risk stage (P = 0.002) and III-IV hepatic aGVHD (P = 0.000) were independent prognostic risk factors affecting both OS rate and TRM rate, while liver dysfunction before transplantation or during conditioning period had no apparent influence on OS rate or TRM rate.

CONCLUSION:

Allo-HSCT would be administrated for the patients with mild impairment of liver function grade 1 and 2.

• Authors: Jun Zhao, Hanyun Ren, Zhixiang Qiu, Mangju Wang, Wei Liu, Weilin Xu, Yuan Li, Yuhua Sun, Lihong Wang, Zeyin Liang, Yujun Dong, Jinping Ou, Wensheng Wang, Yue Yin, Xinan Cen, Qian Wang
• Journal: Zhonghua nei ke za zhi (Zhonghua Nei Ke Za Zhi) Vol. 53 Issue 2 Pg. 99-103 (Feb 2014) ISSN: 0578-1426 [Print] China
• PMID: 24767159 (Publication Type: English Abstract, Journal Article, Research Support, Non-U.S. Gov't)

Topics

• Adolescent
• Adult
• Child
• Child, Preschool
• Female
• Hematopoietic Stem Cell Transplantation (methods)
• Hepatic Insufficiency
• Humans
• Liver Function Tests
• Male
• Middle Aged
• Retrospective Studies
• Risk Factors
• Survival Rate
• Transplantation Conditioning
• Transplantation, Homologous
• Treatment Outcome
• Young Adult