Pretransplantation Liver Function Impacts on the Outcome of Allogeneic Hematopoietic Stem Cell Transplantation: A Study of 455 Patients
Por:
Barba, P, Pinana, JL, Fernandez-Aviles, F, Perez-Simon, JA, Martino, R, Lopez-Guerrero, E, Valcarcel, D, Rovira, M, Novelli, S, Campos-Varela, I, Lopez-Anglada, L, Vidal, X, Corral, LL, Carreras, E, Sierra, J
Publicada:
1 nov 2011
Resumen:
Liver dysfunction is frequent before allogeneic stem cell transplantation (allo-SCT). However, its characteristics and impact on transplantation outcomes are uncertain, especially in the reduced-intensity conditioning (RIC) setting. We analyzed 455 patients receiving an allo-SCT in 3 Spanish centers. Pretransplantation aspartate aminotransferase (AST), alanine aminotransaminase (ALT), gamma-glutamyl transpeptidase (GGT), alkaline phosphatase (AP), total bilirubin, and international normalized ratio were analyzed. Pretransplantation liver function test abnormalities were found in 94 (22%) patients. The most frequent cause of pretransplantation liver dysfunction was isolated elevation of GGT/AP (n = 49, 53%). Patients with high bilirubin levels before allo-SCT showed higher 4-year nonrelapse mortality (4y-NRM) (hazard ratio [HR] 2 [95% confidence interval [CI] 1.1-3.8] P = .02) and patients with high GGT levels showed higher 100-day NRM and lower 4-year overall survival (OS) (HR 3.4 [95% CI 1.8-6.7] P <.001, and HR 2 [95% CI 1.4-3], P = .001), respectively. High levels of transaminases did not influence on survival or mortality. In conclusion, hepatic dysfunction before allo-SCT is frequent and has an impact on transplantation outcomes. The best indicator of liver dysfunction still has to be determined. Biol Blood Marrow Transplant 17: 1653-1661 (2011) (C) 2011 American Society for Blood and Marrow Transplantation
Filiaciones:
Barba, P:
Autonomous Univ Barcelona, Dept Hematol, Hosp Santa Creu & St Pau, Barcelona 08025, Spain
Hosp Univ Vail dHebron, Dept Hematol, Barcelona, Spain
Pinana, JL:
Autonomous Univ Barcelona, Dept Hematol, Hosp Santa Creu & St Pau, Barcelona 08025, Spain
Hosp Manises, Clin Hematol Div, Manises, Spain
Fernandez-Aviles, F:
Hosp Clin Barcelona, Barcelona, Spain
Perez-Simon, JA:
Hosp Univ Salamanca, Salamanca, Spain
Martino, R:
Autonomous Univ Barcelona, Dept Hematol, Hosp Santa Creu & St Pau, Barcelona 08025, Spain
Lopez-Guerrero, E:
Autonomous Univ Barcelona, Vall dHebron Res Inst, USMIB, Barcelona 08025, Spain
Valcarcel, D:
Autonomous Univ Barcelona, Dept Hematol, Hosp Santa Creu & St Pau, Barcelona 08025, Spain
Hosp Univ Vail dHebron, Dept Hematol, Barcelona, Spain
Rovira, M:
Hosp Clin Barcelona, Barcelona, Spain
Novelli, S:
Autonomous Univ Barcelona, Dept Hematol, Hosp Santa Creu & St Pau, Barcelona 08025, Spain
Campos-Varela, I:
Univ Autonoma Barcelona, Dept Internal Med, Ctr Invest Biomed Red Enfermedades Hepat & Digest, Hosp Univ Vall dHebron,Liver Unit, E-08193 Barcelona, Spain
Lopez-Anglada, L:
Hosp Univ Salamanca, Salamanca, Spain
Vidal, X:
Autonomous Univ Barcelona, Vall dHebron Univ Hosp, Clin Pharmacol Serv, Barcelona 08025, Spain
Corral, LL:
Hosp Univ Salamanca, Salamanca, Spain
Carreras, E:
Hosp Clin Barcelona, Barcelona, Spain
Sierra, J:
Autonomous Univ Barcelona, Dept Hematol, Hosp Santa Creu & St Pau, Barcelona 08025, Spain
Hybrid Gold
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