Department of Oncology, Karmanos Cancer Institute/Wayne State University, Detroit, Michigan.
Department of Internal Medicine, Division of Hematology Oncology, Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan.
Am J Hematol. 2019 Oct;94(10):1072-1080. doi: 10.1002/ajh.25575. Epub 2019 Jul 29.
Liver Graft-versus-host disease (GVHD) is common in patients with post-transplant liver dysfunction following allogeneic hematopoietic stem cell transplantation (AHSCT). Oftentimes, the diagnosis is made clinically, and liver biopsy is deferred. Our objective was to evaluate the risk factors and clinical outcomes of liver GVHD among patients who developed post-transplant liver dysfunction. Additionally, we evaluated the feasibility of liver biopsy in this population. We compared outcomes between liver GVHD and a "non-liver GVHD" group, which consisted of other etiologies of post-transplant liver dysfunction. Between January 2003 and December 2010, 249 patients developed post-transplant liver dysfunction following AHSCT: 124 patients developed liver GVHD and 125 were in the "non-liver GVHD" group. The incidence of acute and chronic liver GVHD at one year was 15.7% and 31.0%, respectively. The competing risk analysis revealed full intensity conditioning regimen (Hazard ratio [HR], 1.76; P = .008) and related donor (HR, 1.68; P = .004) as independent risk factors for liver GVHD. The time-varying covariate Cox regression analysis with competing risk event, demonstrated that liver GVHD was independently associated with higher non-relapse mortality, and adverse relapse-free and overall survival. A total of 112 liver biopsies were performed in 100 patients. No major complications were observed. Liver biopsy confirmed prebiopsy hypotheses in 49% of cases, and led to treatment modification in 49% of patients. Our study shows that liver GVHD is associated with adverse survival. Liver biopsy is safe and often helps directing care in this setting.
肝移植物抗宿主病（GVHD）在异基因造血干细胞移植（AHSCT）后出现肝功能障碍的患者中很常见。通常，临床诊断为肝 GVHD，且会延迟进行肝活检。我们的目的是评估发生移植后肝功能障碍的患者中肝 GVHD 的危险因素和临床结局。此外，我们评估了在该人群中进行肝活检的可行性。我们比较了肝 GVHD 患者和“非肝 GVHD”组（由移植后肝功能障碍的其他病因组成）的结局。2003 年 1 月至 2010 年 12 月，249 例 AHSCT 后发生移植后肝功能障碍：124 例患者发生肝 GVHD，125 例患者为“非肝 GVHD”组。一年时急性和慢性肝 GVHD 的发生率分别为 15.7%和 31.0%。竞争风险分析显示，高强度预处理方案（危险比 [HR]，1.76；P =.008）和相关供体（HR，1.68；P =.004）是肝 GVHD 的独立危险因素。具有竞争风险事件的时变协变量 Cox 回归分析表明，肝 GVHD 与更高的非复发死亡率以及不良的无复发生存和总生存独立相关。在 100 例患者中进行了 112 次肝活检。未观察到主要并发症。肝活检在 49%的病例中证实了术前假设，并导致 49%的患者改变了治疗方案。我们的研究表明，肝 GVHD 与不良生存相关。肝活检是安全的，并且经常有助于指导这种情况下的治疗。
