Value of liver elastography and abdominal ultrasound for detection of complications of allogeneic hemopoietic SCT

Abstract

Hepatic complications contribute to morbidity and mortality after allogeneic hemopoietic SCT. Liver Doppler ultrasound and elastography represent promising methods for pretransplant risk assessment and early detection of complications. Ultrasound (liver and spleen size, liver perfusion) and elastography (transient elastography (TE); right liver lobe acoustic radiation force impulse imaging (r-ARFI); left liver lobe ARFI (l-ARFI)) were prospectively evaluated in patients with indications for allo-SCT. Measurements were performed before and repeatedly after SCT. Results were compared with the incidence of life-threatening complications and death during the first 150 days after SCT. Of 59 included patients, 16 suffered from major complications and 9 of them died within the follow-up period. At baseline, liver and spleen size, liver perfusion, TE and r-ARFI did not differ significantly between patients with and without severe complications. In contrast, l-ARFI was significantly elevated in patients who later developed severe complications (1.58 ± 0.30 m/s vs 1.37 ± 0.27 m/s, P = 0.030). After SCT, l-ARFI values remained elevated and TE showed increasing liver stiffness in patients with complications. The value of conventional liver ultrasound for prediction of severe SCT complications is limited. Increased values for TE and l-ARFI are associated with severe SCT complications and demand further evaluation.

Liver Stiffness Measurement Allows Early Diagnosis of Veno-Occlusive Disease/Sinusoidal Obstruction Syndrome in Adult Patients Who Undergo Hematopoietic Stem Cell Transplantation: Results from a Monocentric Prospective Study

“…We have shown that the median LSM values of patients with VOD/SOS were significantly higher than those of patients with other therapy-associated liver complications (eg, acute cholecystitis, cholangitis, DILI related to antimycotic drugs, hepatic GVHD, isolated liver biochemical alterations, fulminant Epstein-Barr virusrelated hepatitis reactivation) regardless of CTC grade (Figure 4). This result is apparently in contrast with the findings of Karlas et al [29], who reported significantly higher LSM values measured by TE in 5 of 59 HSCT recipients who developed severe hepatic involvement after HSCT (CTC grade 4 to 5) compared with the others who did not (mean, 6.2 § 1.5 kPa versus 4.7 § 1.7 kPa). A possible explanation for this discrepancy is the fact that VOD/SOS was not analyzed separately but was included in the severe complication group without any specifications.…”

“…To date, among these techniques, only transient elastography (TE) [28À30] and point-shear wave elastography by acoustic radiation force impulse imaging [29,31] have been evaluated for assessment of liver complications in pediatric patients undergoing HSCT. No study has yet been reported on the role of LSM in VOD/SOS assessment in the setting of adult HSCT.…”

Usefulness of liver stiffness measurement in predicting hepatic veno-occlusive disease development in patients who undergo HSCT

“…A recent paper has shown that LS measurement using ARFI (Acoustic Radiation Force Impulse) and Fibroscan could represent an additional diagnostic parameter for adult patients with suspected post-transplant hepatic injury; in fact, LS pretransplant values using ARFIo 1.25 m/s were correlated with the absence of severe complications after allo-HSCT. 14 The aim of our study was to verify the role of LS measurement in predicting VOD development in a pediatric population who underwent HSCT using Fibroscan.…”

Longitudinal evaluation of liver stiffness in three pediatric patients with veno‐occlusive disease

“…The possible role for on the use of LSM in the HSCT setting was suggested by Karlas et al, who stated that LSM, assessed both by TE (FibroScan®, Echosens, France) and ARFI, pSWE, could predict the onset of hepatobiliary complications in adult patients undergoing HSCT. In addition, Colecchia et al first and Reddivalla et al subsequently have demonstrated that LSM, using TE and two‐dimensional SWE, respectively, had a sudden increase up to more than a week before the diagnosis of VOD/SOS in pediatric patients.…”

“…reflects the health of the liver that increases due to several pathogenetic factors (fibrosis, inflammation, congestion, central venous pressure, and cholestasis) and which is used as the standard non-invasive diagnostic assessment of portal hypertension in patients with chronic liver disease. 9 The possible role for on the use of LSM in the HSCT setting was suggested by Karlas et al, 10 who stated that LSM, assessed both by TE (FibroScan®, Echosens, France) and ARFI, pSWE, could predict the onset of hepatobiliary complications in adult patients undergoing HSCT. In addition, Colecchia et al 11 first and Reddivalla et al 12 subsequently have demonstrated that LSM, using TE and two-dimensional SWE, respectively, had a sudden increase up to more than a week before the diagnosis of VOD/SOS in pediatric patients.…”