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P.-E. Debureaux et al.
(including three cases that were proven after liver biopsy) and were associated with skin or gut GvHD in all cases but one. Liver tests improved after GvHD treatment in six cases. SOS diagnosis was suspected when patients had clinical criteria based on classifications (EBMT, Seattle and Baltimore). SOS diagnosis was retrospectively retained when proven on liver biopsy (n=3) or in patients with usual ultrasonography and Doppler criteria (n=3), in the absence of other causes (GvHD, infectious or drug- related) and according to the clinical evolution. Drug- induced liver injury was observed in 48 patients after exposure to drugs within the conditioning regimen (n=32), azole antifungal therapy (n=12) or cyclosporine A (n=4), with normal imaging, no clinical sign for SOS or GvHD, and no positive biological test for infectious dis- ease. All improved after drug withdrawal. A liver biopsy was performed in ten (7%) patients when liver blood test abnormalities were not explained by clinical, laboratory or imaging results. Diagnosis was established after pathology analysis in nine patients: SOS (n=3), GvHD
(n=3), DILI (n=1), HEV infection (n=1) and cholangitis lenta (n=1). One biopsy was not conclusive. Of the eight patients in whom liver biopsy was performed using the transjugular route, six had a hepatic venous pressure gra- dient (HVPG) <10 mmHg and did not have a SOS, while the two patients with an HVPG >10 mmHg had a con- firmed SOS in biopsy.
Elastography baseline values are not associated with the occurrence of liver involvements after allogeneic hematopoietic stem cell transplantation
Median basal values before transplantation were 5.4 kPa (interquartile range [IQR], 4.1-6.8) for transient elastogra- phy and 6.0 kPa (IQR, 4.9-7.8) for 2D-SWE (Figure 3A). Mean elastography measures from the three radiologists were not significantly different, suggesting that they were not dependent of the operator (P=0.39; Online Supplementary Figure S1). TE measure was obtained in 413 out of 432 procedures (two failures at baseline, five at day+7 and 12 at day+14). TE measures did not reach qual-
Figure 1. Patients flowchart. Out of 212 patients, 161 patients consented to the study and were transplanted between July 2017 and July 2019, 146 had a baseline evaluation followed by sequential ultrasonography and elastography measures at day+7 and day+14. Eighty-one patients developed liver blood tests disorders, among which 15 fulfilled European Society for Blood and Marrow Transplantation (EBMT) criteria for sinusoidal obstruction syndrome (SOS) diagnosis, including six with a proven SOS.
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