Locasciulli A, Testa M, Valsecchi M G, Bacigalupo A, Solinas S, Tomas J F, Ljungman P, Alberti A
Clinica Pediatrica Università di Milano, Ematologia Pediatrica, Ospedal San Gerardo, Monza (Milano), Itlay.
Transplantation. 1999 Nov 27;68(10):1486-91. doi: 10.1097/00007890-199911270-00010.
Severe liver disease, including fulminant hepatic failure and venoocclusive disease can occur after bone marrow transplantation (BMT). The aim of our study was to assess risk factors for veno occlusive disease and severe liver disease occurring within 6 months from BMT.
A total of 193 consecutive patients from 15 BMT Centers were prospectively enrolled between January and June 1995. Data on donors and recipients before and after transplant were collected and included age, gender, alanine aminotransferase (ALT), hepatitis B (HBV), and hepatitis C virus (HCV) markers, hematological disease, status and type of BMT, conditioning regimen and graft versus host disease prophylaxis. Statistical analysis included univariate descriptive and multivariate analysis based on logistic regression on major end-points.
Forty-three of 193 patients died during the study period, and liver disease was the main cause of death (13 of 43, 30%). Incidence of severe veno occlusive disease was 8%, fulminant hepatic failure 0.5% and 12% of cases had ALT >500 U/L (normal < or =42 U/L). A de novo HBV or HCV infection occurred in 3.2 and 7% of patients respectively. Predictive risk factors for life-threatening liver disease were: unrelated donors (relative risk=5.8, confidence interval=1.7-19.8) and abnormal BMT donor ALT (relative risk=6.3, confidence interval=1. 5- 25.5).
This study indicates that ongoing or previous infection with HBV or HCV in donor or recipient is not an absolute contraindication for BMT. However, abnormal ALT levels in BMT donors were a significant predictor of potentially lethal liver complications. The occurrence of de novo HBV or HCV infection did not correlate with severity of liver disease observed in the first 6 months posttransplant. These findings should be carefully evaluated before disregarding HBV or HCV positive siblings with normal transaminase levels in favor of unrelated donors.
严重肝脏疾病，包括暴发性肝衰竭和肝静脉闭塞病，可发生于骨髓移植（BMT）后。我们研究的目的是评估BMT后6个月内发生肝静脉闭塞病和严重肝脏疾病的危险因素。
1995年1月至6月，前瞻性纳入了来自15个BMT中心的193例连续患者。收集移植前后供者和受者的数据，包括年龄、性别、丙氨酸转氨酶（ALT）、乙肝（HBV）和丙肝病毒（HCV）标志物、血液系统疾病、BMT的状态和类型、预处理方案以及移植物抗宿主病的预防措施。统计分析包括基于主要终点的逻辑回归的单变量描述性分析和多变量分析。
193例患者中有43例在研究期间死亡，肝脏疾病是主要死因（43例中的13例，30%）。严重肝静脉闭塞病的发生率为8%，暴发性肝衰竭为0.5%，12%的病例ALT>500 U/L（正常≤42 U/L）。分别有3.2%和7%的患者发生了新发HBV或HCV感染。危及生命的肝脏疾病的预测危险因素为：非血缘供者（相对危险度=5.8，可信区间=1.7 - 19.8）和BMT供者ALT异常（相对危险度=6.3，可信区间=1.5 - 25.5）。
本研究表明，供者或受者目前或既往感染HBV或HCV并非BMT的绝对禁忌证。然而，BMT供者ALT水平异常是潜在致命性肝脏并发症的重要预测指标。新发HBV或HCV感染的发生与移植后前6个月观察到的肝脏疾病严重程度无关。在不考虑转氨酶水平正常的HBV或HCV阳性同胞而选择非血缘供者之前，应仔细评估这些发现。
