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Ferrata Storti Foundation
Haematologica 2021 Volume 106(9):2374-2383
Elastography improves accuracy of early hepato-biliary complications diagnosis after allogeneic stem cell transplantation
Pierre-Edouard Debureaux,1* Pierre Bourrier,2* Pierre Emmanuel Rautou,3,4 Anne-Marie Zagdanski,2 Morgane De Boutiny,2 Simona Pagliuca,1
Aurélien Sutra de Galy,1 Marie Robin,1 Régis Peffault de Latour,1,4
Aurélie Plessier,3 Flore Sicre de Fontbrune,1 Aliénor Xhaard,1
Pedro Henrique Prata,1 Dominique Valla,3,4 Gérard Socie1,4# and David Michonneau1,4#
1Hematology and Transplantation Unit, Saint Louis Hospital, APHP, Paris; 2Radiology Unit, Saint Louis Hospital, APHP, Paris; 3DHU Unit, Pôle des Maladies de l’Appareil Digestif, Service d'Hépatologie, Centre de Référence des Maladies Vasculaires du Foie, Hôpital Beaujon, AP-HP, Clichy and 4Université de Paris, INSERM U976, Paris, France
*PED and PB contributed equally as co-first authors. #GS and DM contributed equally as co-senior authors
ABSTRACT
Significant morbidity and mortality have been associated with liver complications after allogeneic hematopoietic stem cell transplanta- tion (allo-HSCT). Causes and consequences of these hepato-biliary complications are various and might be life-threatening. A high misdi- agnosis rate has been reported because of a weak correlation between clinical, laboratory and imaging data. Liver elastography, a liver stiffness measure, is able to assess liver fibrosis and portal hypertension in most liver diseases, but data after allo-HSCT are scarce. Our aim was to determine the interest of sequential liver stiffness measurements for the diagnosis of early hepatic complications after allo-HSCT. Over a 2-year time period, 161 consecutive adult patients were included and 146 were analyzed. Ultrasonography and elastography measurements were per- formed before transplantation, at day+7 and day+14 by three different experienced radiologists unaware of the patients’ clinical status. Eighty- one (55%) patients had liver involvements within the first 100 days after allo-HSCT. Baseline elastography was not predictive for the occur- rence of overall liver abnormalities. A significant increase in two-dimen- sional real-time shearwave elastography (2D-SWE) was found in patients with sinusoidal obstruction syndrome (SOS). Fifteen patients (10%) fulfilled European Society for Blood and Marrow Transplantation (EBMT) score criteria and twelve (8%) reached Baltimore criteria for SOS diagnosis, but only six (4%) had a confirmed SOS. 2D-SWE at day+14 allowed early detection of SOS (AUROC=0.84, P=0.004) and improved sensibility (75%), specificity (99%) and positive predictive value (60%) over the Seattle, Baltimore or EBMT scores. A 2D-SWE measurement above 8.1 kPa at day+14 after allo-HSCT seems a prom- ising, non-invasive, and reproducible tool for early and accurate diagno- sis of SOS.
Introduction
Over the past two decades, overall survival rate after allo-HSCT has improved.1 However, transplantation-related mortality (TRM) remains a significant cause of death, with a reported 15% to 35% rate in the current era.1 Hepato-biliary com- plications lead to significant morbidity and TRM after allo-HSCT.2 They include liver graft-versus-host disease (GvHD), sinusoidal obstruction syndrome (SOS), drug-induced hepatotoxicity, cholangitis lenta, malignant infiltration, iron over- load, hemodynamic modification and biliary obstruction.2 Previous studies have reported a higher TRM rate in patients who had a high level of bilirubinemia
Compications in Hematology
Correspondence:
DAVID MICHONNEAU
david.michonneau@aphp.fr
Received: March 5, 2020. Accepted: July 27, 2020. Pre-published: July 30, 2020.
https://doi.org/10.3324/haematol.2019.245407 ©2021 Ferrata Storti Foundation
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