Predicting hepatic complications of allogeneic hematopoietic stem cell transplantation using liver stiffness measurement

Karlas, Thomas; Weiße, Tina; Petroff, David; Beer, Sebastian; Döhring, Christine; Gnatzy, Franziska; Niederwieser, Dietger; Behre, Gerhard; Mössner, Joachim; Fischer, Janett; Tröltzsch, Matthias; Keim, Volker; Franke, Georg‐Nikolaus

doi:10.1038/s41409-019-0464-x

Cited by 15 publications

(12 citation statements)

References 33 publications

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“…30 In addition, it has been shown that transient elastography and point shear wave values before allo-HSCT were higher in patients developing severe or life-threatening liver complications after allo-HSCT. 31 Our study did not identify baseline values as a marker for subsequent liver injury after allo-HSCT, but baseline measures might help the interpretation of post-transplantation measures.…”

Section: A B C D E Fmentioning

confidence: 75%

“…Finally, 2D-SWE was not operator-dependent in our study as in others. 37 Many techniques of elastography have been proposed to predict hepatic complications 30,31 or to diagnose SOS after allo-HSCT. 36,38,39 In a pediatric cohort of 22 patients, sequential measures of TE after allo-HSCT showed increased TE measures 3 to 6 days before clinical signs in five SOS cases (based on Seattle or Baltimore classification).…”

Section: A B C D E Fmentioning

confidence: 99%

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

et al. 2020

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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.

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Section: A B C D E Fmentioning

confidence: 75%

Section: A B C D E Fmentioning

confidence: 99%

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

et al. 2020

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“…An independent study has shown that patients with an increase of at least two fold the normal value of γGT, bilirubin, and alkaline phosphatase have a consistent (32%) risk of severe cGvHD, which reaches 50% when also transaminases are at least two fold higher than normal value 14 . In addition high pre-transplant level of γGT are associated with a 3.6 fold increased risk of developing liver disease at 100 days after HSCT 15,16 . Barba and colleagues have shown that increasing pre-transplant bilirubin and γGT have an adverse effect on the outcome of patients receiving reduced intensity conditioning transplant.…”

Section: Discussionmentioning

confidence: 99%

“…The two year CI of moderate/severe cGvHD was 12% (95% CI [8][9][10][11][12][13][14][15][16][17][18] in the low risk group, 20% (95% CI [16][17][18][19][20][21][22][23][24] in the intermediate risk group and 52% (95% CI 40-65) in the high risk group (p<0.00001,…”

Section: Identifying Variables Predictive Of Moderate Severe Cgvhdmentioning

confidence: 96%

The day 100 score predicts moderate to severe cGVHD, transplant mortality, and survival after hematopoietic cell transplantation

et al. 2022

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The aim of this study was to develop a predictive score for moderate-severe chronic graft-versus-host disease (cGVHD) on day +100 after allogeneic stem cell transplantation (HSCT). We studied 1292 patients allografted between 1990 and 2016, alive on day +100 after transplant, without cGvHD, and with full biochemistry laboratory values available. Patients were randomly assigned to a training and a validation cohort (ratio 1:1). In the training cohort, a multivariate analysis identified four independent predictors of moderate-severe cGvHD: gammaglutamyltransferase ≥75 UI/l, creatinine ≥1 mg/dl, cholinesterase ≤4576 UI/l and albumin ≤4 g/dl. A score of 1 was assigned to each variable, producing a low (0-1), intermediate (2-3) and high (4) score. The cumulative incidence (CI) of moderate-severe cGvHD was 12%, 20% and 52% (p<0.0001) in the training cohort, and 13%, 24% and 33% (p=0.002) in the validation cohort. The 5 year CI of transplant related mortality (TRM) was 5%, 14%, 27%(p<0.0001) and 5%, 16%, 31%(p<0.0001), respectively. The 5 year survival was 64%, 57%, 54%(p=0.009) and 70%, 59%, 42%(p=0.0008) in the two cohorts respectively . In conclusion, Day100 score predicts cGvHD, TRM and survival, and, if validated in a separate group of patients, could be considered for trials of pre-emptive therapy.

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“…Die Bedeutung der LSM für Risikoprädiktion und Diagnostik vor und nach Allo-SCT wurde in mehreren prospektiven Studien untersucht [14,15,16]…”

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Bedeutung der Lebersteifigkeitsmessung für Risikoprädiktion und Komplikationsmanagement bei allogener Stammzelltransplantation

Karlas

Franke

2021

Z Gastroenterol

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Predicting hepatic complications of allogeneic hematopoietic stem cell transplantation using liver stiffness measurement

Cited by 15 publications

References 33 publications

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

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

The day 100 score predicts moderate to severe cGVHD, transplant mortality, and survival after hematopoietic cell transplantation

Bedeutung der Lebersteifigkeitsmessung für Risikoprädiktion und Komplikationsmanagement bei allogener Stammzelltransplantation

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