Locasciulli A, Alberti A, de Bock R, Cordonnier C, Einsele H, Engelhard D, Grundy J, Reusser P, Ribaud P, Ljungman P
Clinica Pediatrica, Università di Milano, Italy.
Bone Marrow Transplant. 1994 Nov;14(5):833-7.
This survey investigated allogeneic bone marrow transplantation (BMT) policy in European BMT units by questionnaire, in relation to pre-transplant liver disease. It also assessed diagnostic standards for viral hepatitis infections and their prevalence in BMT candidates. Sixty-three EBMT centers from 22 countries participated in the survey. Median pre-transplant prevalences of HBsAg and anti-HCV positivity were 3.5% (range 0-15%) and 5% (range 0-45%), respectively. Forty-six (73%) centers adopt the policy of cancelling or postponing BMT in patients with ALT abnormalities but in four of these centers, BMT is not delayed when progressive disease or acute leukemia is present. In 17 institutions (27%) BMT was reported to be carried out irrespective of transaminase values. Data on fatal post-BMT liver disease were provided by 45 centers. The overall mortality rate for liver failure was 4.5% (258 of 5788) with no differences between centers performing or not performing BMT in cases of ALT elevation. These results indicate that there is strong concern in most European BMT units about performing BMT in the presence of ALT elevation and prospective studies on its real impact on fatal post-BMT liver disease should be conducted.
本调查通过问卷调查研究了欧洲骨髓移植（BMT）单位关于移植前肝脏疾病的同种异体骨髓移植政策。它还评估了病毒性肝炎感染的诊断标准及其在BMT候选者中的患病率。来自22个国家的63个欧洲血液和骨髓移植协会（EBMT）中心参与了此次调查。移植前乙肝表面抗原（HBsAg）和丙肝抗体（抗-HCV）阳性的中位数患病率分别为3.5%（范围0-15%）和5%（范围0-45%）。46个（73%）中心采取对谷丙转氨酶（ALT）异常患者取消或推迟BMT的政策，但在其中4个中心，若存在进展性疾病或急性白血病，则不推迟BMT。在17个机构（27%）中，据报告无论转氨酶值如何都进行BMT。45个中心提供了BMT后致命性肝脏疾病的数据。肝衰竭的总体死亡率为4.5%（5788例中有258例），在ALT升高情况下进行或不进行BMT的中心之间没有差异。这些结果表明，大多数欧洲BMT单位非常关注在ALT升高情况下进行BMT的问题，应该对其对BMT后致命性肝脏疾病的实际影响开展前瞻性研究。
