The role of hepatitis C and B virus infections as risk factors for severe liver complications following allogeneic BMT: A prospective study by the Infectious Disease Working Party of the European Blood and Marrow Transplantation Group

被引:65
作者
Locasciulli, A
Testa, M
Valsecchi, MG
Bacigalupo, A
Solinas, S
Tomas, JF
Ljungman, P
Alberti, A
机构
[1] Univ Milan, Nuovo Osped San Gerardo, Pediat Clin, I-20052 Monza, Milano, Italy
[2] Univ Milan, Ist Stat Med & Biometria, I-20122 Milan, Italy
[3] Osped San Martino Genova, Ctr Trapianto Midollo, Genoa, Italy
[4] Univ Rome La Sapienza, Cattedra Ematol, Rome, Italy
[5] Hosp Univ La Princesa, Dept Haematol, Madrid, Spain
[6] Huddinge Hosp, Dept Med, Div Clin Haematol & Oncol, S-14186 Huddinge, Sweden
[7] Karolinska Inst, S-14186 Huddinge, Sweden
[8] Univ Padua, Clin Med 5, Padua, Italy
关键词
D O I
10.1097/00007890-199911270-00010
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
Background Severe liver disease, including fulminant hepatic failure and venoocclusive disease can occur after bone marrow transplantation (BMT). The aim of our study was to assess risk factors for veno occlusive disease and severe liver disease occurring within 6 months from BMT. Methods. A total of 193 consecutive patients from 15 BMT Centers were prospectively enrolled between January and June 1995. Data on donors and recipients before and after transplant were collected and included age, gender, alanine amiotransferase (ALT), hepatitis B (HBV), and hepatitis C virus (HCV) markers, hematological;sal disease, status and type of BMT, conditioning regimen and graft versus host disease prophylaxis. Statistical analysis included univariate; descriptive and multivariate analysis based on logistic regression on major end-points. Results Forty-three of 193 patients died during the study period, and liver disease was the main cause of death (13 of 43, 30%). Incidence of severe veno occlusive disease was 8%, fulminant hepatic failure 0.5% and 12% of cases had ALT >500 U/L (normal less than or equal to 42 U/L). A de novo HBV or HCV infection occurred in 3.2 and 7% of patients respectively. Predictive risk factors for life threatening liver disease were: unrelated donors (relative risk=5.8, confidence interval=1.7-19.8) and abnormal BMT donor ALT (relative risk=6.3, confidence interval=1.5-25.5). Conclusions. This study indicates that ongoing or previous infection with HBV or HCV in donor or recipient is not an absolute contraindication for BMT. However, abnormal ALT levels in BMT donors were a significant predictor of potentially lethal liver complications. The occurrence of de novo HBV or HCV infection did not correlate with severity of liver disease observed in the first 6 months posttransplant. These findings should be carefully evaluated before disregarding HBV or HCV positive siblings with normal transaminase levels in favor of unrelated donors.
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页码:1486 / 1491
页数:6
相关论文
共 25 条
[1]   Liver dysfunction in allogeneic bone marrow transplantation recipients - Influence of pre- and posttransplantation hepatic lesions [J].
Azar, N ;
Valla, D ;
AbdelSamad, I ;
Hoang, C ;
Fretz, C ;
Sutton, L ;
Fournel, JJ ;
LeCharpentier, Y ;
Binet, JL ;
Leblond, V .
TRANSPLANTATION, 1996, 62 (01) :56-61
[2]   FULMINANT AND SUBFULMINANT LIVER-FAILURE - DEFINITIONS AND CAUSES [J].
BERNUAU, J ;
RUEFF, B ;
BENHAMOU, JP .
SEMINARS IN LIVER DISEASE, 1986, 6 (02) :97-106
[3]  
Carreras E, 1998, BONE MARROW TRANSPL, V21, pS239
[4]  
CHEN PM, 1995, TRANSPLANTATION, V59, P1139
[5]  
FRICKHOFEN N, 1994, BLOOD, V83, P1998
[6]   VENOOCCLUSIVE DISEASE OF THE LIVER FOLLOWING BONE-MARROW TRANSPLANTATION [J].
JONES, RJ ;
LEE, KSK ;
BESCHORNER, WE ;
VOGEL, VG ;
GROCHOW, LB ;
BRAINE, HG ;
VOGELSANG, GB ;
SENSENBRENNER, LL ;
SANTOS, GW ;
SARAL, R .
TRANSPLANTATION, 1987, 44 (06) :778-783
[7]   FULMINANT HEPATITIS-C VIRAL-INFECTION AFTER ALLOGENEIC BONE-MARROW TRANSPLANTATION [J].
KANAMORI, H ;
FUKAWA, H ;
MARUTA, A ;
HARANO, H ;
KODAMA, F ;
MATSUZAKI, M ;
MIYASHITA, H ;
MOTOMURA, S ;
OKUBO, T ;
YOSHIBA, M ;
SEKIYAMA, K .
AMERICAN JOURNAL OF THE MEDICAL SCIENCES, 1992, 303 (02) :109-111
[8]  
KLINGEMANN HG, 1994, BONE MARROW TRANSPL, V14, pS14
[9]   LONG-TERM EFFECTS OF HEPATITIS-C VIRUS-INFECTION IN ALLOGENEIC BONE-MARROW TRANSPLANT RECIPIENTS [J].
LJUNGMAN, P ;
JOHANSSON, N ;
ASCHAN, J ;
GLAUMANN, H ;
LONNQVIST, B ;
RINGDEN, O ;
SPARRELID, E ;
SONNERBORG, A ;
WINIARSKI, J ;
GAHRTON, G .
BLOOD, 1995, 86 (04) :1614-1618
[10]  
LOCASCIULLI A, 1995, BONE MARROW TRANSPL, V16, P407