Risk factors and prognosis of hepatic acute GvHD after allogeneic hematopoietic cell transplantation View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2015-09-14

AUTHORS

Y Arai, J Kanda, H Nakasone, T Kondo, N Uchida, T Fukuda, K Ohashi, K Kaida, K Iwato, T Eto, Y Kanda, H Nakamae, T Nagamura-Inoue, Y Morishima, M Hirokawa, Y Atsuta, M Murata

ABSTRACT

Hepatic acute GvHD (aGvHD) is associated with high mortality owing to poor response to immunosuppressive therapy. The pathogenesis of hepatic aGvHD differs from that of other lesions, and specific risk factors related to pre-transplant liver conditions should be determined. We conducted a cohort study by using a Japanese transplant registry database (N=8378). Of these subjects, 1.5% had hepatitis C virus Ab (HCV-Ab) and 9.4% had liver dysfunction (elevated transaminase or bilirubin levels) before hematopoietic cell transplantation (HCT). After HCT, the cumulative incidence of hepatic aGvHD was 6.7%. On multivariate analyses, HCV-Ab positivity (hazard ratio (HR), 1.93; P=0.02) and pre-transplant liver dysfunction (HR, 1.85; P<0.01), as well as advanced HCT risk, unrelated donors, HLA mismatch and cyclosporine as GvHD prophylaxis, were significant risk factors for hepatic aGvHD, whereas hepatitis B virus surface Ag was not. Hepatic aGvHD was a significant risk factor for low overall survival and high transplant-related mortality in all aGvHD grades (P<0.01). This study is the first to show the relationship between pre-transplant liver conditions and hepatic aGvHD. A prospective study is awaited to validate the results of this study and establish a new strategy especially for high-risk patients. More... »

PAGES

96-102

Journal

TITLE

Bone Marrow Transplantation

ISSUE

1

VOLUME

51

Author Affiliations

  • Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
  • Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
  • Division of Blood and Marrow Transplantation, School of Medicine, Stanford University, California, USA
  • Department of Hematology, Federation of National Public Service Personnel Mutual Aid Associations Toranomon Hospital, Tokyo, Japan
  • Division of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
  • Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
  • Division of Hematology, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan
  • Department of Hematology, Hiroshima Red Cross Hospital & Atomic-bomb Survivors Hospital, Hiroshima, Japan
  • Department of Hematology, Hamanomachi Hospital, Fukuoka, Japan
  • Department of Hematology, Osaka City University, Osaka, Japan
  • Department of Cell Processing and Transfusion, Research Hospital, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
  • Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Aichi, Japan
  • Department of General Internal Medicine and Clinical Laboratory Medicine, Graduate School of Medicine, Akita University, Akita, Japan
  • Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Aichi, Japan
  • Department of Hematology and Oncology, Nagoya University Graduate School of Medicine, Aichi, Japan
  • Identifiers

    URI

    http://scigraph.springernature.com/pub.10.1038/bmt.2015.205

    DOI

    http://dx.doi.org/10.1038/bmt.2015.205

    DIMENSIONS

    https://app.dimensions.ai/details/publication/pub.1029266219

    PUBMED

    https://www.ncbi.nlm.nih.gov/pubmed/26367230


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