Arai Sally, Lee Linda A, Vogelsang Georgia B
Johns Hopkins Oncology Center, Baltimore, MD 21231, USA.
J Hematother Stem Cell Res. 2002 Apr;11(2):215-29. doi: 10.1089/152581602753658420.
Hepatic injury is a common complication of hematopoietic stem cell transplantation (HSCT) and carries a high risk of early morbidity and mortality. Evaluation of the patient for hepatic complications should begin in the pretransplant period with the identification of pretransplant risk factors, such as hepatitis status, that may predict severe liver complications and continue through the early and late transplant periods. Early hepatic complications include drug toxicity, hepatic veno-occlusive disease (VOD), acute graft-versus-host disease (GVHD), infection, and cholestatic disorders. With increased survival of HSCT recipients, long-term liver complications from chronic viral hepatitis, chronic GVHD, and iron overload are being reported. The diagnosis and management of hepatic disorders in transplant can be complex, because one must decide whether a given symptom is due to one or a combination of diverse causes. Making the diagnosis can be crucial, because specific therapies can improve one condition but worsen another. This review describes a systematic approach to the evaluation of HSCT patients with hepatic complications with an emphasis on the need to intervene early with radiologic imaging and liver biopsy. Updated treatment options are also discussed. It is hoped that a standard approach will help to streamline clinical management of these very complex patients.
肝损伤是造血干细胞移植（HSCT）的常见并发症，具有较高的早期发病和死亡风险。对于肝并发症患者的评估应在移植前阶段就开始，识别如肝炎状态等可能预测严重肝脏并发症的移植前风险因素，并贯穿移植的早期和晚期阶段。早期肝并发症包括药物毒性、肝静脉闭塞病（VOD）、急性移植物抗宿主病（GVHD）、感染和胆汁淤积性疾病。随着HSCT受者生存率的提高，慢性病毒性肝炎、慢性GVHD和铁过载导致的长期肝脏并发症也有报道。移植中肝脏疾病的诊断和管理可能很复杂，因为必须判断特定症状是由多种不同原因中的一种还是多种原因共同导致的。做出诊断至关重要，因为特定疗法可能改善一种情况但会使另一种情况恶化。本综述描述了一种评估有肝并发症的HSCT患者的系统方法，重点强调早期进行放射学成像和肝活检干预的必要性。还讨论了最新的治疗选择。希望一种标准方法将有助于简化这些非常复杂患者的临床管理。
