1
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Cabel T, Pascu CM, Ghenea CS, Dumbrava BF, Gunsahin D, Andrunache A, Negoita LM, Panaitescu A, Rinja EM, Pavel C, Plotogea OM, Stan-Ilie M, Sandru V, Mihaila M. Exceptional Liver Transplant Indications: Unveiling the Uncommon Landscape. Diagnostics (Basel) 2024; 14:226. [PMID: 38275473 PMCID: PMC10813978 DOI: 10.3390/diagnostics14020226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 01/14/2024] [Accepted: 01/18/2024] [Indexed: 01/27/2024] Open
Abstract
Liver transplantation represents the definitive intervention for various etiologies of liver failure and encompasses a spectrum of rare indications crucial to understanding the diverse landscape of end-stage liver disease, with significantly improved survival rates over the past three decades. Apart from commonly encountered liver transplant indications such as decompensated cirrhosis and liver cancer, several rare diseases can lead to transplantation. Recognition of these rare indications is essential, providing a lifeline to individuals facing complex liver disorders where conventional treatments fail. Collaborative efforts among healthcare experts lead not only to timely interventions but also to the continuous refinement of transplant protocols. This continued evolution in transplant medicine promises hope for those facing diverse and rare liver diseases, marking a paradigm shift in the landscape of liver disease management.
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Affiliation(s)
- Teodor Cabel
- Department of Gastroenterology, Clinical Emergency Hospital of Bucharest, 014461 Bucharest, Romania; (T.C.); (D.G.); (L.-M.N.); (E.M.R.)
| | - Cristina Madalina Pascu
- Department of Internal Medicine, Fundeni Clinical Institute, 022328 Bucharest, Romania (M.M.)
| | - Catalin Stefan Ghenea
- Department of Gastroenterology, Clinical Emergency Hospital of Bucharest, 014461 Bucharest, Romania; (T.C.); (D.G.); (L.-M.N.); (E.M.R.)
| | - Bogdan Florin Dumbrava
- Department of Gastroenterology, “Sf. Ioan” Emergency Hospital, 014461 Bucharest, Romania
| | - Deniz Gunsahin
- Department of Gastroenterology, Clinical Emergency Hospital of Bucharest, 014461 Bucharest, Romania; (T.C.); (D.G.); (L.-M.N.); (E.M.R.)
| | - Andreea Andrunache
- Department of Internal Medicine, Fundeni Clinical Institute, 022328 Bucharest, Romania (M.M.)
| | - Livia-Marieta Negoita
- Department of Gastroenterology, Clinical Emergency Hospital of Bucharest, 014461 Bucharest, Romania; (T.C.); (D.G.); (L.-M.N.); (E.M.R.)
| | - Afrodita Panaitescu
- Department of Gastroenterology, Clinical Emergency Hospital of Bucharest, 014461 Bucharest, Romania; (T.C.); (D.G.); (L.-M.N.); (E.M.R.)
| | - Ecaterina Mihaela Rinja
- Department of Gastroenterology, Clinical Emergency Hospital of Bucharest, 014461 Bucharest, Romania; (T.C.); (D.G.); (L.-M.N.); (E.M.R.)
| | - Christopher Pavel
- Department of Gastroenterology, Clinical Emergency Hospital of Bucharest, 014461 Bucharest, Romania; (T.C.); (D.G.); (L.-M.N.); (E.M.R.)
- Department 5, “Carol Davila” University of Medicine and Pharmacy, 050447 Bucharest, Romania
| | - Oana-Mihaela Plotogea
- Department of Gastroenterology, Clinical Emergency Hospital of Bucharest, 014461 Bucharest, Romania; (T.C.); (D.G.); (L.-M.N.); (E.M.R.)
- Department 5, “Carol Davila” University of Medicine and Pharmacy, 050447 Bucharest, Romania
| | - Madalina Stan-Ilie
- Department of Gastroenterology, Clinical Emergency Hospital of Bucharest, 014461 Bucharest, Romania; (T.C.); (D.G.); (L.-M.N.); (E.M.R.)
- Department 5, “Carol Davila” University of Medicine and Pharmacy, 050447 Bucharest, Romania
| | - Vasile Sandru
- Department of Gastroenterology, Clinical Emergency Hospital of Bucharest, 014461 Bucharest, Romania; (T.C.); (D.G.); (L.-M.N.); (E.M.R.)
- Department 5, “Carol Davila” University of Medicine and Pharmacy, 050447 Bucharest, Romania
| | - Mariana Mihaila
- Department of Internal Medicine, Fundeni Clinical Institute, 022328 Bucharest, Romania (M.M.)
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2
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Stueck AE, Fiel MI. Hepatic graft-versus-host disease: what we know, when to biopsy, and how to diagnose. Hum Pathol 2023; 141:170-182. [PMID: 37541449 DOI: 10.1016/j.humpath.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 04/19/2023] [Accepted: 07/24/2023] [Indexed: 08/06/2023]
Abstract
Graft-versus-host disease (GVHD) is one of the serious complications that may develop after hematopoietic cell transplantation (HCT), for hematologic malignancies, solid organ transplantation, and other hematologic disorders. GVHD develops due to T lymphocytes present in the graft attacking the host antigens, which results in tissue damage. A significant number of HCT patients develop acute or chronic GVHD, which may affect multiple organs including the liver. The diagnosis of hepatic GVHD (hGVHD) is challenging as many other conditions in HCT patients may lead to liver dysfunction. Particularly challenging among the various conditions that give rise to liver dysfunction is differentiating sinusoidal obstruction syndrome and drug-induced liver injury (DILI) from hGVHD on clinical grounds and laboratory tests. Despite the minimal risks involved in performing a liver biopsy, the information gleaned from the histopathologic changes may help in the management of these very complex patients. There is a spectrum of histologic features found in hGVHD, and most involve histopathologic changes affecting the interlobular bile ducts. These include nuclear and cytoplasmic abnormalities including dysmorphic bile ducts, apoptosis, and cholangiocyte necrosis, among others. The hepatitic form of hGVHD typically shows severe acute hepatitis. With chronic hGVHD, there is progressive bile duct loss and eventually fibrosis. Accurate diagnosis of hGVHD is paramount so that timely treatment and management can be initiated. Techniques to prevent and lower the risk of GVHD from developing have recently evolved. If a diagnosis of acute GVHD is made, the first-line of treatment is steroids. Recurrence is common and steroid resistance or dependency is not unusual in this setting. Second-line therapies differ among institutions and have not been uniformly established. The development of GVHD, particularly hGVHD, is associated with increased morbidity and mortality.
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Affiliation(s)
- Ashley E Stueck
- Department of Pathology, Dalhousie University, 715 - 5788 University Avenue, Halifax, NS, B3H 2Y9, Canada.
| | - M Isabel Fiel
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, 1468 Madison Ave, New York, NY, 10029, USA.
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3
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Dezan MGF, Cavalcante LN, Cotrim HP, Lyra AC. Hepatobiliary disease after bone marrow transplant. Expert Rev Gastroenterol Hepatol 2023; 17:129-143. [PMID: 36655915 DOI: 10.1080/17474124.2023.2169671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Bone marrow transplantation (BMT) is the standard treatment for several hematologic pathologies. Post-BMT patients may develop hepatobiliary complications that impact morbidity and mortality. The differential diagnosis may include drug-induced liver injury (DILI), sepsis-associated liver injury (SALI), sinusoidal obstruction syndrome (SOS), graft-versus-host disease (GVHD), viral hepatitis, ischemic and fulminant hepatitis, among others. AREA COVERED Defining the etiology of hepatobiliary injury is challenging due to the overlapping symptoms. Thus, it is necessary to be aware of and understand the clinical characteristics of these hepatobiliary complications and provide adequate management with possible better outcomes. We reviewed the scientific literature focused on early hepatobiliary complications associated with BMT. We searched the PubMed database using the following descriptors: hepatic complications, drug-induced liver disease, graft-versus-host disease, cholestasis, sepsis, sinusoidal obstruction syndrome, cytomegalovirus, viral hepatitis, bone marrow transplantation, and hematopoietic stem cell transplantation. EXPERT OPINION Post-BMT hepatobiliary complications comprise several differential diagnoses and are challenges for the hepatologist's clinical practice. When evaluating these patients, it is necessary to consider the temporality between the use of certain medications, the increase in liver enzymes, and the presence of infection, in addition to applying diagnostic criteria and complementary tests for a specific diagnosis.
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Affiliation(s)
- Maria Gabriela Fernandes Dezan
- Instituto D'Or de Pesquisa e Ensino (IDOR) and Hospital São Rafael Gastro-Hepatology Service, Hospital São Rafael, Salvador, Bahia, Brazil.,Gastro-Hepatology Service - University Hospital Professor Edgard Santos (HUPES), PPGMS - Federal University of Bahia, Salvador, Bahia, Brazil
| | - Lourianne Nascimento Cavalcante
- Instituto D'Or de Pesquisa e Ensino (IDOR) and Hospital São Rafael Gastro-Hepatology Service, Hospital São Rafael, Salvador, Bahia, Brazil.,Gastro-Hepatology Service - University Hospital Professor Edgard Santos (HUPES), PPGMS - Federal University of Bahia, Salvador, Bahia, Brazil
| | - Helma Pinchemel Cotrim
- Gastro-Hepatology Service - University Hospital Professor Edgard Santos (HUPES), PPGMS - Federal University of Bahia, Salvador, Bahia, Brazil
| | - Andre Castro Lyra
- Instituto D'Or de Pesquisa e Ensino (IDOR) and Hospital São Rafael Gastro-Hepatology Service, Hospital São Rafael, Salvador, Bahia, Brazil.,Gastro-Hepatology Service - University Hospital Professor Edgard Santos (HUPES), PPGMS - Federal University of Bahia, Salvador, Bahia, Brazil
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4
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Faraci M, Bertaina A, Dalissier A, Ifversen M, Schulz A, Gennery A, Burkhardt B, Badell Serra I, Diaz-de-Heredia C, Lanino E, Lankester AC, Gruhn B, Matthes-Martin S, Kühl JS, Varotto S, Paillard C, Guilmatre A, Sastre A, Abecasis M, Garwer B, Sedlacek P, Boelens JJ, Beohou E, Bader P. Solid organ transplantation after hematopoietic stem cell transplantation in childhood: A multicentric retrospective survey. Am J Transplant 2019; 19:1798-1805. [PMID: 30586230 DOI: 10.1111/ajt.15240] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 11/24/2018] [Accepted: 12/14/2018] [Indexed: 01/25/2023]
Abstract
We report data obtained from a retrospective multicenter pediatric survey on behalf of the European Society for Blood and Marrow Transplantation (EBMT). Information on solid organ transplantation (SOT) performed in pediatric recipients of either autologous or allogeneic hematopoietic stem cell transplantation (HSCT) between 1984 and 2016 was collected in 20 pediatric EBMT Centers (25.6%). Overall, we evaluated data on 44 SOTs following HSCT including 20 liver (LTx), 12 lung (LuTx), 6 heart (HTx), and 6 kidney (KTx) transplantations. The indication for SOT was organ failure related to intractable graft-vs-host disease in 16 children (36.3%), acute or chronic HSCT-related toxicity in 18 (40.9%), and organ dysfunction related to the underlying disease in 10 (22.8%). The median follow-up was 10.9 years (95% confidence interval: 1.7-29.5). The overall survival rate at 1 and 5 years after SOT was 85.7% and 80.4%, respectively: it was 74% and 63.2% after LTx, 83.2% after HTx, and 100% equally after LuTx and KTx. This multicenter survey confirms that SOT represents a promising option in children with severe organ failure occurring after HSCT. Additional studies are needed to further establish the effectiveness of SOT after HSCT and to better understand the mechanism underlying this encouraging success.
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Affiliation(s)
- Maura Faraci
- Hematopoietic Stem Cell Transplantation Unit, Hematology-Oncology, Istituto G Gaslini, Genova, Italy
| | - Alice Bertaina
- Dipartimento di Onco-Ematologia Pediatrica, IRCSS Ospedale Pediatrico Bambino Gesù, Rome, Italy.,Division of Stem Cell Transplantation and Regenerative Medicine, Department of Pediatrics, School of Medicine, Stanford University, Stanford, California
| | - Arnaud Dalissier
- European Society for Blood and Marrow Transplantation Pediatric Disease Working Party, Paris, France
| | - Marianne Ifversen
- Department for Children and Adolescents, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ansgar Schulz
- Department of Pediatrics, University Medical Center, Ulm, Germany
| | - Andrew Gennery
- Institute of Cellular Medicine, Pediatric Immunology Department, Newcastle University, Great North Children's Hospital, Newcastle-upon-Tyne, UK
| | - Birgit Burkhardt
- Pediatric Hematology and Oncology, University Hospital Münster, Muenster, Germany
| | - Isabel Badell Serra
- Pediatric Hematopoietic Transplant Unit, Sant Pau Hospital, Barcelona, Spain
| | - Cristina Diaz-de-Heredia
- Department of Pediatric Oncology and Hematology, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Edoardo Lanino
- Hematopoietic Stem Cell Transplantation Unit, Hematology-Oncology, Istituto G Gaslini, Genova, Italy
| | - Arjan C Lankester
- Department of Pediatrics Stem Cell Transplantation Program, Leiden University Medical Center, Leiden, The Netherlands
| | - Bernd Gruhn
- Department of Pediatrics, Jena University Hospital, Jena, Germany
| | | | - Joern S Kühl
- Department Pediatric Hematology, Oncology, Hemostaseology, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Stefania Varotto
- Clinic of Pediatric Hemato-Oncology, Department of Women's and Children's Health, University Hospital of Padova, Padova, Italy
| | - Catherine Paillard
- Hematology, Oncology and Stem Cell Transplantation, Department of Pediatrics, Hôpital Hautepierre, Strasbourg, France
| | - Audrey Guilmatre
- Service of Pediatric Hematology-Oncology, Hôpital Armand Trousseau, Paris, France
| | - Ana Sastre
- Unidad de Hematología y Oncología Pediátrica, Hospital Universitario La Paz, Madrid, Spain
| | | | | | | | - Jaap J Boelens
- Pediatric Blood and Marrow Transplantation Program, Laboratory for Translational Immunology Tumor-immunology, University Medical Center, Utrecht, The Netherlands.,Stem Cell Transplant and Cellular Therapies Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Eric Beohou
- European Society for Blood and Marrow Transplantation Pediatric Disease Working Party, Paris, France
| | - Peter Bader
- Department for Children and Adolescents, Division for Stem Cell Transplantation and Immunology, University Hospital Frankfurt, Frankfurt am Main, Germany
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5
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Runde J, Azzam RK. Hepatobiliary Manifestations in Systemic Disease. Pediatr Ann 2018; 47:e458-e464. [PMID: 30423189 DOI: 10.3928/19382359-20181023-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Liver disease in children occurs via a multitude of primary illnesses such as autoimmune hepatopathy, biliary atresia, and nonalcoholic fatty liver disease. However, jaundice, hepatitis, and alterations in liver tests can often be a manifestation of systemic diseases. The liver is involved in many critical functions such as circulation, immunity, toxin clearance, and metabolism; when the heart, lungs, gastrointestinal tract, immune system, or endocrine systems are compromised, the liver will be affected. This article reviews common causes of liver injury as well as highlights key associations that should not be missed when diagnosing and managing children with liver disease. Becoming familiar with patterns of liver injury and arranging clues in the context of a thorough history and physical examination can help providers navigate the broad differential diagnosis of secondary liver disease. [Pediatr Ann. 2018;47(11):e458-e464.].
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6
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Vanishing Bile Ducts in the Long Term after Pediatric Hematopoietic Stem Cell Transplantation. Biol Blood Marrow Transplant 2018; 24:2250-2258. [DOI: 10.1016/j.bbmt.2018.07.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 07/08/2018] [Indexed: 01/28/2023]
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7
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Brockmann JG, Broering DC, Raza SM, Rasheed W, Hashmi SK, Chaudhri N, Nizami IY, Alburaiki JAH, Shagrani MA, Ali T, Aljurf M. Solid organ transplantation following allogeneic haematopoietic cell transplantation: experience from a referral organ transplantation center and systematic review of literature. Bone Marrow Transplant 2018; 54:190-203. [PMID: 30082851 PMCID: PMC7092162 DOI: 10.1038/s41409-018-0255-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Accepted: 05/20/2018] [Indexed: 01/08/2023]
Abstract
Solid organ transplantation (SOT) following haematopoietic cell transplantation (HCT) is a rare event. Uncertainty exists whether such recipients are at higher risk of relapse of underlying haematological disease or at increased risk of developing infectious or immunological complications and malignancies following SOT. The experience at our referral organ transplantation center and the present literature of SOT (n = 198) in recipients following previous HCT was systematically reviewed. Outcome analysis of 206 SOT recipients following HCT challenges the validity of the frequently stated comparable outcome with recipients without prior HCT. SOT recipients after HCT are younger and have a higher mortality and morbidity in comparison with "standard" recipients. Rejection rates for SOT recipients following HCT appear to be lower for all organs, except for liver transplantation. In the setting of liver transplantation following HCT, mortality for recipients of deceased donor grafts appears to be exceptionally high, although experience with grafts of living donors are favourable. Morbidity was mostly associated with infectious and malignant complications. Of note some SOT recipients who received solid organ donation from the same HCT donor were able to achieve successful withdrawal of immune suppression. Despite limited follow-up, recipients with prior HCT show a different course after SOT, necessitating attention and closer follow-up.
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Affiliation(s)
- Jens G Brockmann
- Department of Surgery, Organ Transplant Center, All King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
| | - Dieter C Broering
- Department of Surgery, Organ Transplant Center, All King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Syed M Raza
- Department of Surgery, Organ Transplant Center, All King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Walid Rasheed
- Department of Medical Oncology, All King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Shahrukh K Hashmi
- Department of Medical Oncology, All King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Naeem Chaudhri
- Department of Medical Oncology, All King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Imran Y Nizami
- Organ Transplant Centre, Lung Transplant Medicine, All King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Jehad A H Alburaiki
- Department of Cardiology, All King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Mohamed A Shagrani
- Organ Transplant Center, Department of Paediatric Transplant Hepatology, Organ Transplant Center, All King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Tariq Ali
- Organ Transplant Center, Department of Kidney and Pancreas Transplant Nephrology, Organ Transplant Center, All King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Mahmoud Aljurf
- Department of Medical Oncology, All King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
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8
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Wang Z, Lu CL, Wen MY, Yang L. Persistent abnormal liver function tests may predict development of cirrhosis in chronic hepatic graft-versus-host disease. Clin Res Hepatol Gastroenterol 2016; 40:e19-22. [PMID: 26184349 DOI: 10.1016/j.clinre.2015.06.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2015] [Revised: 06/05/2015] [Accepted: 06/11/2015] [Indexed: 02/05/2023]
Affiliation(s)
- Zhu Wang
- Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, 37#, Guoxue Lane, 610041 Chengdu, Sichuan, China; Institution of Interventional Radiology, West China Hospital, Sichuan University, Sichuan, China
| | - Chang-Li Lu
- Department of Pathology, West China Hospital, Sichuan University, Sichuan, China
| | - Mao-Yao Wen
- Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, 37#, Guoxue Lane, 610041 Chengdu, Sichuan, China
| | - Li Yang
- Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, 37#, Guoxue Lane, 610041 Chengdu, Sichuan, China.
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9
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Abstract
A 59-year-old female received a matched related donor stem cell transplant for chronic myelogenous leukemia. After being successfully treated with prednisone for chronic graft versus host disease that initially started 50 days posttransplant, she developed hepatic dysfunction during the steroid taper on day 531, as evidenced by jaundice, elevated liver enzymes, and increased bilirubin. Liver biopsy showed histology suggestive of autoimmune-like hepatitis, which is a rare manifestation of chronic “hepatitic” graft versus host disease.
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Affiliation(s)
- Nick M. Baniak
- University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Rani Kanthan
- University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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10
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Shulman HM, Cardona DM, Greenson JK, Hingorani S, Horn T, Huber E, Kreft A, Longerich T, Morton T, Myerson D, Prieto VG, Rosenberg A, Treister N, Washington K, Ziemer M, Pavletic SZ, Lee SJ, Flowers MED, Schultz KR, Jagasia M, Martin PJ, Vogelsang GB, Kleiner DE. NIH Consensus development project on criteria for clinical trials in chronic graft-versus-host disease: II. The 2014 Pathology Working Group Report. Biol Blood Marrow Transplant 2015; 21:589-603. [PMID: 25639770 DOI: 10.1016/j.bbmt.2014.12.031] [Citation(s) in RCA: 179] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Accepted: 12/24/2014] [Indexed: 12/17/2022]
Abstract
The 2005 National Institute of Health (NIH) Consensus Conference outlined histopathological diagnostic criteria for the major organ systems affected by both acute and chronic graft-versus-host disease (GVHD). The 2014 Consensus Conference led to this updated document with new information from histopathological studies of GVHD in the gut, liver, skin, and oral mucosa and an expanded discussion of GVHD in the lungs and kidneys. The recommendations for final histological diagnostic categories have been simplified from 4 categories to 3: no GVHD, possible GVHD, and likely GVHD, based on better reproducibility achieved by combining the previous categories of "consistent with GVHD" and "definite GVHD" into the single category of "likely GVHD." Issues remain in the histopathological characterization of GVHD, particularly with respect to the threshold of histological changes required for diagnostic certainty. Guidance is provided for the incorporation of biopsy information into prospective clinical studies of GVHD, particularly with respect to biomarker validation.
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Affiliation(s)
- Howard M Shulman
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Diana M Cardona
- Department of Pathology, Duke University Medical Center, Durham, North Carolina
| | - Joel K Greenson
- Department of Pathology, University of Michigan, Ann Arbor, Michigan
| | - Sangeeta Hingorani
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Departments of Pediatrics, Gastroenterology and Pathology, University of Washington, Seattle, Washington; Seattle Children's Hospital, Seattle, Washington
| | - Thomas Horn
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
| | - Elisabeth Huber
- Institute of Pathology, University of Regensburg, Regensburg, Germany
| | - Andreas Kreft
- Institute of Pathology, University Medical Center Mainz, Mainz, Germany
| | - Thomas Longerich
- Institute of Pathology, University Hospital RWTH Aachen, Aachen, Germany
| | - Thomas Morton
- Departments of Pediatrics, Gastroenterology and Pathology, University of Washington, Seattle, Washington
| | - David Myerson
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Pathology, University of Washington, Seattle, Washington
| | - Victor G Prieto
- Department of Pathology, University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Avi Rosenberg
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Nathaniel Treister
- Division of Oral Medicine and Dentistry, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts
| | - Kay Washington
- Department of Pathology, Microbiology and Immunology, Vanderbilt University, Nashville, Tennessee
| | - Mirjana Ziemer
- Department of Dermatology, University Hospital of Leipzig, Leipzig, Germany
| | - Steven Z Pavletic
- Experimental Transplantation and Immunology Branch, National Cancer Institute, Bethesda, Maryland
| | - Stephanie J Lee
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Mary E D Flowers
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Kirk R Schultz
- Department of Pediatrics, BC Children's Hospital/University of British Columbia, Vancouver, British Columbia
| | - Madan Jagasia
- Division of Hematology-Oncology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Paul J Martin
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Georgia B Vogelsang
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - David E Kleiner
- Department of Pathology, University of Texas M.D. Anderson Cancer Center, Houston, Texas.
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11
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Norvell JP. Liver disease after hematopoietic cell transplantation in adults. Transplant Rev (Orlando) 2014; 29:8-15. [PMID: 25315987 DOI: 10.1016/j.trre.2014.08.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2014] [Revised: 08/10/2014] [Accepted: 08/22/2014] [Indexed: 01/22/2023]
Abstract
Liver-related complications constitute a large component of the overall morbidity and mortality associated with hematopoietic cell transplantation. Affecting up to 80% of allogeneic HCT recipients, prompt recognition and treatment are essential. The differential diagnosis is broad and is best categorized by time of onset after transplantation. Early complications include drug-induced liver injury, sinusoidal obstruction syndrome, and graft-versus-host disease. Late complications include infectious sequelae, cirrhosis, and hepatic malignancies. Patients being considered for hematopoietic cell transplantation should be screened and evaluated for liver-related complications to help improve outcomes.
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Affiliation(s)
- J P Norvell
- Department of Medicine, Division of Digestive Diseases, Emory Transplant Center, Emory University, Atlanta, GA, USA.
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12
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Majhail NS, Rizzo JD, Lee SJ, Aljurf M, Atsuta Y, Bonfim C, Burns LJ, Chaudhri N, Davies S, Okamoto S, Seber A, Socie G, Szer J, Van Lint MT, Wingard JR, Tichelli A. [Recommended screening and preventive practices for long-term survivors after hematopoietic cell transplantation]. Bone Marrow Transplant 2014; 47:337-41. [PMID: 24975331 DOI: 10.1038/bmt.2012.5] [Citation(s) in RCA: 149] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Advances in hematopoietic cell transplantation (HCT) technology and supportive care techniques have led to improvements in long-term survival after HCT. Emerging indications for transplantation, introduction of newer graft sources (eg, umbilical cord blood) and transplantation of older patients using less intense conditioning regimens have also contributed to an increase in the number of HCT survivors. These survivors are at risk for developing late complications secondary to pre-, peri-, and posttransplantation exposures and risk factors. Guidelines for screening and preventive practices for HCT survivors were published in 2006. An international group of transplantation experts was convened in 2011 to review contemporary literature and update the recommendations while considering the changing practice of transplantation and international applicability of these guidelines. This review provides the updated recommendations for screening and preventive practices for pediatric and adult survivors of autologous and allogeneic HCT.
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13
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Upadhyay K, Fine RN. Solid organ transplantation following end-organ failure in recipients of hematopoietic stem cell transplantation in children. Pediatr Nephrol 2014; 29:1337-47. [PMID: 23949630 DOI: 10.1007/s00467-013-2587-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Revised: 07/12/2013] [Accepted: 07/23/2013] [Indexed: 10/26/2022]
Abstract
Hematopoietic stem cell transplantation (HSCT) is an accepted treatment modality for various malignant and non-malignant disorders of the lympho-hematopoietic system. Patient survival rate has increased significantly with the use of this procedure. However, with the increase in disease-free patient survival rates, complications including various organ toxicities are also common. Kidney, liver, lung, heart, and skin are among those solid organs that are commonly affected and frequently lead to organ dysfunction and eventually end-organ disease. Conservative measures may or may not be successful in managing the organ failure in these patients. Solid organ transplantation has been shown to be promising in those patients who fail conservative management. This review will summarize the causes of solid organ (kidney, liver, and lung) dysfunction and the available data on transplantation of these solid organs in post-HSCT recipients.
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Affiliation(s)
- Kiran Upadhyay
- Division of Pediatric Nephrology, Department of Pediatrics, Stony Brook Long Island Children's Hospital, State University of New York at Stony Brook, Stony Brook, NY, 11794, USA,
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Zeidan AM, Wozney JL, Torbenson M, Krok K, Bolaños-Meade J. Successful treatment of severe refractory hepatic graft-versus-host disease by cadaveric liver transplant. Leuk Lymphoma 2013; 54:2756-9. [PMID: 23517590 DOI: 10.3109/10428194.2013.788178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Amer M Zeidan
- Department of Oncology, the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University , Baltimore, MD , USA
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Englert C, Ganschow R. Liver transplantation in a child with liver failure due to chronic graft-versus-host disease after allogeneic hematopoietic stem cell transplantation from the same unrelated living donor. Pediatr Transplant 2012; 16:E325-7. [PMID: 22462486 DOI: 10.1111/j.1399-3046.2012.01685.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We report a case of a six-yr-old boy who developed chronic GVHD of the liver, intestines, and skin following allogeneic hematopoietic SCT. The boy received an allogeneic hematopoietic stem cell transplant at the age of two yr because of early recurrence of ALL. Chimerism analysis showed complete chimerism. In the following year, he developed GVHD despite adequate immunosuppressive therapy. Liver biopsy showed liver GVHD resulting in liver cirrhosis by the age of five yr. LTx was performed with a left liver lobe from the unrelated donor from whom the stem cells had been taken. Immunosuppressive therapy consisted of low-dose steroids and low-dose cyclosporine. The postoperative course was uneventful. Graft function was excellent, and we performed protocol biopsies at seven days and three wk as well as three, six, and nine months after transplantation; none of these showed any signs of rejection or GVHD. Immunosuppressive therapy was discontinued nine months after LTx. Three yr after transplantation, the boy is in good condition with normal graft function. To our knowledge, this is the first report on LTx following allogeneic hematopoietic SCT from the same unrelated living donor.
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Affiliation(s)
- C Englert
- Department of Pediatric Hepatology and Liver Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Majhail NS, Rizzo JD, Lee SJ, Aljurf M, Atsuta Y, Bonfim C, Burns LJ, Chaudhri N, Davies S, Okamoto S, Seber A, Socie G, Szer J, Lint MTV, Wingard JR, Tichelli A. Recommended screening and preventive practices for long-term survivors after hematopoietic cell transplantation. Rev Bras Hematol Hemoter 2012; 34:109-33. [PMID: 23049402 PMCID: PMC3459383 DOI: 10.5581/1516-8484.20120032] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2012] [Accepted: 01/27/2012] [Indexed: 02/06/2023] Open
Abstract
Advances in hematopoietic cell transplantation (HCT) technology and supportive care techniques have led to improvements in long-term survival after HCT. Emerging indications for transplantation, introduction of newer graft sources (e.g. umbilical cord blood) and transplantation of older patients using less intense conditioning regimens have also contributed to an increase in the number of HCT survivors. These survivors are at risk for developing late complications secondary to pre-, periand post-transplant exposures and risk-factors. Guidelines for screening and preventive practices for HCT survivors were published in 2006. An international group of transplant experts was convened in 2011 to review contemporary literature and update the recommendations while considering the changing practice of transplantation and international applicability of these guidelines. This review provides the updated recommendations for screening and preventive practices for pediatric and adult survivors of autologous and allogeneic HCT.
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Affiliation(s)
- Navneet Singh Majhail
- National Marrow Donor Program, Minneapolis, MN, USA ; Center for International Blood and Marrow Transplant Research, Minneapolis, MN, USA
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Majhail NS, Rizzo JD, Lee SJ, Aljurf M, Atsuta Y, Bonfim C, Burns LJ, Chaudhri N, Davies S, Okamoto S, Seber A, Socie G, Szer J, Van Lint MT, Wingard JR, Tichelli A. Recommended screening and preventive practices for long-term survivors after hematopoietic cell transplantation. Hematol Oncol Stem Cell Ther 2012; 5:1-30. [PMID: 22446607 DOI: 10.5144/1658-3876.2012.1] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Advances in hematopoietic cell transplantation (HCT) technology and supportive care techniques have led to improvements in long-term survival after HCT. Emerging indications for transplantation, introduction of newer graft sources (eg, umbilical cord blood) and transplantation of older patients using less intense conditioning regimens have also contributed to an increase in the number of HCT survivors. These survivors are at risk for developing late complications secondary to pre-, peri-, and posttransplant exposures and risk factors. Guidelines for screening and preventive practices for HCT survivors were published in 2006. An international group of transplantation experts was convened in 2011 to review contemporary literature and update the recommendations while considering the changing practice of transplantation and international applicability of these guidelines. This review provides the updated recommendations for screening and preventive practices for pediatric and adult survivors of autologous and allogeneic HCT.
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Affiliation(s)
- N S Majhail
- National Marrow Donor Program, Minneapolis, MN 55413-1753, USA.
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Majhail NS, Rizzo JD, Lee SJ, Aljurf M, Atsuta Y, Bonfim C, Burns LJ, Chaudhri N, Davies S, Okamoto S, Seber A, Socie G, Szer J, Van Lint MT, Wingard JR, Tichelli A. Recommended screening and preventive practices for long-term survivors after hematopoietic cell transplantation. Biol Blood Marrow Transplant 2011; 18:348-71. [PMID: 22178693 DOI: 10.1016/j.bbmt.2011.12.519] [Citation(s) in RCA: 223] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2011] [Accepted: 12/07/2011] [Indexed: 12/26/2022]
Abstract
Advances in hematopoietic cell transplantation (HCT) technology and supportive care techniques have led to improvements in long-term survival after HCT. Emerging indications for transplantation, introduction of newer graft sources (eg, umbilical cord blood) and transplantation of older patients using less intense conditioning regimens have also contributed to an increase in the number of HCT survivors. These survivors are at risk for developing late complications secondary to pre-, peri-, and posttransplantation exposures and risk factors. Guidelines for screening and preventive practices for HCT survivors were published in 2006. An international group of transplantation experts was convened in 2011 to review contemporary literature and update the recommendations while considering the changing practice of transplantation and international applicability of these guidelines. This review provides the updated recommendations for screening and preventive practices for pediatric and adult survivors of autologous and allogeneic HCT.
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Affiliation(s)
- Navneet S Majhail
- National Marrow Donor Program, Minneapolis, Minnesota 55413-1753, USA.
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Teisseyre M, Teisseyre J, Kalicinski P, Wolska-Kusnierz B, Ismail H, Bernatowska E, Markiewicz-Kijewska M, Ostoja-Chyzynska A, Jankowska I, Kluge P, Pawlowska J, Szymczak M. Liver Transplantation for Severe Hepatic Graft-Versus-Host Disease in Two Children After Hematopoietic Stem Cell Transplantation. Transplant Proc 2010; 42:4608-10. [DOI: 10.1016/j.transproceed.2010.09.170] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2010] [Accepted: 09/16/2010] [Indexed: 11/26/2022]
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Bunin N, Guzikowski V, Rand ER, Goldfarb S, Baluarte J, Meyers K, Olthoff KM. Solid organ transplants following hematopoietic stem cell transplant in children. Pediatr Transplant 2010; 14:1030-5. [PMID: 20846242 DOI: 10.1111/j.1399-3046.2010.01401.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
SOT may be indicated for a select group of pediatric patients who experience permanent organ failure following HSCT. However, there is limited information available about outcomes. We identified eight children at our center who received an SOT following an HSCT. Patients were six months to 18 yr at HSCT. Diseases for which children underwent HSCT included thalassemia, Wiskott-Aldrich syndrome, Shwachman-Diamond/bone marrow failure, sickle cell disease (SCD), erythropoietic porphyria (EP), ALL, chronic granulomatous disease, and neuroblastoma. Time from HSCT to SOT was 13 days to seven yr (median, 27 months. Lung SOT was performed for two patients with BO, kidney transplants for three patients, and liver transplants for three patients (VOD, chronic GVHD). Seven patients are alive with functioning allografts 6-180 months from SOT. Advances in organ procurement, operative technique, immunosuppressant therapy, and infection control may allow SOT for a select group of patients post-HSCT. However, scarcity of donor organs available in a timely fashion continues to be a limiting factor. Children who have undergone HSCT and develop single organ failure should be considered for an SOT if there is a high likelihood of cure of the primary disease.
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Affiliation(s)
- Nancy Bunin
- Divisions of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
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Koenecke C, Hertenstein B, Schetelig J, van Biezen A, Dammann E, Gratwohl A, Ganser A, Schleuning M, Bornhäuser M, Jacobsen N, Kröger N, Niederwieser D, de Witte T, Ruutu T. Solid organ transplantation after allogeneic hematopoietic stem cell transplantation: a retrospective, multicenter study of the EBMT. Am J Transplant 2010; 10:1897-906. [PMID: 20659095 DOI: 10.1111/j.1600-6143.2010.03187.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
To analyze the outcome of solid organ transplantation (SOT) in patients who had undergone allogeneic hematopoietic stem cell transplantation (HSCT), a questionnaire survey was carried out within 107 European Group of Blood and Marrow Transplantation centers. This study covered HSCT between 1984 and 2007 in Europe. Forty-five SOT in 40 patients were reported. Fifteen liver, 15 renal, 13 lung, 1 heart and 1 skin transplantations were performed in 28 centers. Overall survival (OS) of patients after SOT was 78% at 5 years (95% confidence interval [CI], 64% to 92%). OS at 5 years was 100% for renal, 71% (95% CI, 46% to 96%) for liver and 63% (95% CI, 23% to 100%) for lung transplant recipients. The 2-year-incidence of SOT failure was 20% (95% CI, 4% to 36%) in patients with graft-versus-host disease (GvHD) and 7% (95% CI, 0% to 21%) in patients without GvHD before SOT. The relapse incidence for underlying malignant diseases was 4% at 5 years (95% CI, 0% to 12%). In summary, this study shows that selected patients receiving SOT after HSCT have a remarkably good overall and organ survival. These data indicate that SOT should be considered in selected patients with single organ failure after HSCT.
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Affiliation(s)
- C Koenecke
- Hannover Medical School, Department of Hematology, Hemostasis, Hannover, Germany.
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Mori M, Tabata S, Hashimoto H, Inoue D, Kimura T, Shimoji S, Nagai Y, Togami K, Itoh K, Matsushita A, Nagai K, Ikeda E, Kimoto N, Uryuhara K, Kaihara S, Imai Y, Itoh M, Takahashi T. Successful living donor liver transplantation for severe hepatic GVHD histologically resembling autoimmune hepatitis after bone marrow transplantation from the same sibling donor. Transpl Int 2009; 23:e1-4. [DOI: 10.1111/j.1432-2277.2009.01028.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Mendizabal M, Chen T, Reddy KR. Jaundice after allogeneic hematopoietic stem cell transplantation. Hepatology 2009; 50:2044-5. [PMID: 19937681 DOI: 10.1002/hep.23347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Affiliation(s)
- Manuel Mendizabal
- Department of Gastroenterology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
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Mayer J, Krejci M, Pospisil Z, Doubek M, Janikova A, Zackova D, Racil Z, Smardova L, Navratil M, Kamelander J. Successful treatment of steroid-refractory hepatitic variant of liver graft-vs-host disease with pulse cyclophosphamide. Exp Hematol 2009; 37:767-73. [PMID: 19463776 DOI: 10.1016/j.exphem.2009.03.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2008] [Revised: 03/03/2009] [Accepted: 03/13/2009] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Corticosteroid-resistant graft-vs-host disease (GVHD) is difficult to manage and is associated with high morbidity and mortality. No standard treatment exists. We have previously seen good results with pulse cyclophosphamide (Cy) in the treatment of liver GVHD in contrast to gastrointestinal GVHD, and here we report results of pulse Cy protocol in the treatment of steroid-refractory hepatitic variant of liver GVHD, with no association to the gut. MATERIALS AND METHODS Cy was infused at a dose of 1,000 mg/m(2). Twenty-nine cyclophosphamide administrations were given to 21 patients. Median time of GVHD onset and Cy administration after transplantation, or donor lymphocyte infusion, were 58 and 69 days, respectively. RESULTS Eleven patients (52%) achieved complete remission and 6 patients (29%) achieved partial remission. Four patients (19%) did not respond, however, their condition stabilized and, upon additional therapy, three achieved partial remission and one complete remission. Overall survival of all 21 patients is 86%, with median and maximal follow-up of 33 and 81 months, respectively. Toxicity was mild and easily manageable without influencing chimerism or disease status. CONCLUSIONS Pulse Cy seems to be an effective treatment for steroid-refractory hepatitic variant of liver GVHD with a good toxicity profile, which may favor its use instead of drugs with more pronounced immunosuppressive effects.
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Affiliation(s)
- Jiri Mayer
- Department of Internal Medicine, Hemato-Oncology, University Hospital Brno and Masaryk University, Brno, Czech Republic.
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Successful Living-Donor Liver Transplantation for Chronic Hepatic Graft-Versus-Host Disease After Bone Marrow Transplantation for Chronic Granulomatous Disease. Transplantation 2008; 86:367-8. [DOI: 10.1097/tp.0b013e31817c16eb] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Acute and chronic liver disease contributes significantly to morbidity and mortality following hematopoietic cell transplantation (HCT). The best prognostic indicator for the development of severe liver dysfunction is an early rise in liver function test results after HCT. The leading causes soon after HCT are acute graft-versus-host disease (GVHD), sinusoidal obstruction syndrome, drug and total parenteral nutrition hepatotoxicity, sepsis, and viral infection. Hepatic herpesvirus and fungal infections after HCT, though uncommon, can be life-threatening and warrant immediate diagnosis and treatment. Hepatitis B, hepatitis C virus, iron overload, and chronic GVHD are among the most common causes for chronic liver disease after HCT. Because treatments are directed at the underlying etiology of liver disease, prompt diagnosis by means of laboratory tests, hepatic imaging, and often liver biopsy is required after HCT.
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Affiliation(s)
- Josh Levitsky
- Department of Medicine, Division of Hepatology, Northwestern University Feinberg School of Medicine, 675 N. St. Clair, 15-250, Chicago, IL 60611, USA.
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27
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Koenecke C, Kleine M, Schrem H, Krug U, Nashan B, Neipp M, Ganser A, Hertenstein B, Klempnauer J. Sinusoidal obstruction syndrome of the liver after hematopoietic stem cell transplantation: decision making for orthotopic liver transplantation. Int J Hematol 2006; 83:271-4. [PMID: 16720562 DOI: 10.1532/ijh97.na0511] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Sinusoidal obstruction syndrome (SOS) is a specific complication of hematopoietic stem cell transplantation (HSCT) that can lead to substantial morbidity and treatment-related mortality. Heparin is frequently used as prophylaxis of and defibrotide as therapy for mild to moderate SOS. In severe cases of SOS these therapies are often ineffective, and orthotopic liver trans-plantation (OLT) may be the only option. Reports in the literature about the outcome of liver transplantation for SOS are contradictory. We describe our second case of OLT after HSCT. The patient died of intracranial hemorrhage 2 weeks after liver transplantation with good initial organ function. In the first case at our center, however, the patient survived more then 8 years. The reported short- to medium-range survival rate for OLT following HSCT is approximately 50%. On the basis of the experience at our center and the findings in a review of the literature, we developed a rational approach to the selection for liver transplantation of patients with life-threatening liver dysfunction after marrow transplantation.
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Affiliation(s)
- Christian Koenecke
- Departments of Hematology, Hemostasis and Oncology, Hannover Medical School, Hannover, Germany.
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Shulman HM, Kleiner D, Lee SJ, Morton T, Pavletic SZ, Farmer E, Moresi JM, Greenson J, Janin A, Martin PJ, McDonald G, Flowers MED, Turner M, Atkinson J, Lefkowitch J, Washington MK, Prieto VG, Kim SK, Argenyi Z, Diwan AH, Rashid A, Hiatt K, Couriel D, Schultz K, Hymes S, Vogelsang GB. Histopathologic diagnosis of chronic graft-versus-host disease: National Institutes of Health Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-versus-Host Disease: II. Pathology Working Group Report. Biol Blood Marrow Transplant 2006; 12:31-47. [PMID: 16399567 DOI: 10.1016/j.bbmt.2005.10.023] [Citation(s) in RCA: 291] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2005] [Accepted: 10/24/2005] [Indexed: 01/16/2023]
Abstract
This consensus document provides an update for pathologists and clinicians about the interpretation of biopsy results and use of this information in the management of hematopoietic cell transplantation patients. Optimal sampling and tissue preparation are discussed. Minimal criteria for the diagnosis of graft-versus-host disease (GVHD) are proposed, together with specific requirements for the diagnosis of chronic GVHD. Four final diagnostic categories (no GVHD, possible GVHD, consistent with GVHD, and definite GVHD) reflect the integration of histopathology with clinical, laboratory, and radiographic information. Finally, the Working Group developed a set of worksheets to facilitate communication of clinical information to the interpreting pathologist and to aid in clinicopathologic correlation studies. Forms are available at . The recommendations of the Working Group represent a consensus opinion supplemented by evaluation of available peer-reviewed literature. Consensus recommendations and suggested data-capture forms should be validated in prospective clinicopathologic studies.
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Affiliation(s)
- Howard M Shulman
- Department of Pathology, Fred Hutchinson Cancer Research Center, Seattle Cancer Care Alliance, University of Washington School of Medicine, Seattle, Washington 98109, USA.
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