Elastography improves accuracy of early hepato-biliary complications diagnosis after allogeneic stem cell transplantation

Abstract

Significant morbidity and mortality have been associated with liver complications after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Causes and consequences of these hepato-biliary complications are various and might be life-threatening. A high misdiagnosis rate has been reported because of a weak correlation between clinical, laboratory and imaging data. Liver elastography, a liver stiffness measure, is able to assess liver fibrosis and portal hypertension in most liver diseases, but data after allo-HSCT are scarce. Our aim was to determine the interest of sequential liver stiffness measurements for the diagnosis of early hepatic complications after allo-HSCT. Over a two years period of time, 161 consecutive adult patients were included and 146 were analyzed. Ultrasonography and elastography measurements were performed before transplantation, at day+7 and day+14 by three different experienced radiologists unaware of patients'clinical status. Eighty-one (55%) patients had liver involvements within the first 100 days after allo-HSCT. Baseline elastography was not predictive for the occurrence of overall liver abnormalities. A significant increase in 2D real-time shearwave elastography (2D-SWE) was found in patients with sinusoidal obstruction syndrome (SOS). Fifteen patients (10%) fulfilled EBMT score criteria and twelve (8%) reached Baltimore criteria for SOS diagnosis, but only six (4%) had a confirmed SOS. 2D-SWE at day+14 allowed early detection of SOS (AUROC=0.84, p=0.004) and improved sensibility (75%), specificity (99%) and positive predictive value (60%) over the Seattle, Baltimore or EBMT scores. A 2D-SWE measurement above 8.1kPa at day+14 after allo-HSCT seems a promising, non-invasive, and reproducible tool for early and accurate diagnosis of SOS.

Diagnosis and severity criteria for sinusoidal obstruction syndrome/veno-occlusive disease in adult patients: a refined classification from the European society for blood and marrow transplantation (EBMT)

“…LSM gradually decreased following successful specific SOS/VOD treatment. These findings were confirmed by another group that performed transient elastography before alloHCT, at day +7 and day +14 in 146 patients [28]. They found that a significant increase at day +14 allowed early detection of SOS (AUROC = 0.84, p = 0.004) with a high sensibility (75%) and specificity (99%).…”

Utility of the refined EBMT diagnostic and severity criteria 2023 for sinusoidal obstruction syndrome/veno-occlusive disease

“…Second, not all cases were histologically confirmed to have SOS/VOD. Third, elastography [29,30] was not performed at our institution; thus, its efficacy and contribution, compared with ultrasound remain unknown. Despite these limitations, this study is valuable in point of the first report indicating the utility of the refined EBMT criteria 2023.…”

How to prevent sinusoidal obstruction syndrome/veno-occlusive disease?

“…This method is called non-invasive liver biopsy. It can be used at various time points: at the initial stage to assess the risk of SOS/VOD, after HSCT to diagnose SOS/VOD and later to monitor the treatment course [57,58]. Other imaging techniques are also used in the diagnosis of SOS/VOD, such as computed tomography (CT), which is useful in confirming the diagnosis of SOS/VOD, or magnetic resonance imaging (MRI), which is used to assess the risk based on the iron load in the patient's body [57].…”