The role of liver biopsy in the workup of liver dysfunction late after SCT: is the role of iron overload underestimated?
Abnormalities in liver function tests are common in hematopoietic SCT (HSCT) recipients. We retrospectively investigated the role of liver biopsy in determining the cause of elevated liver enzymes and its impact on the management of patients in the post-HSCT setting. A total of 24 consecutive liver biopsies were obtained from 20 patients from September 2003 to December 2007. A definite histopathologic diagnosis was obtained in 91.7% of the biopsies. Iron overload (IO) was found in 75% and GVHD in 54.2% of the patients. The initial clinical diagnosis of GVHD was confirmed in 56.5% and refuted in 43.5% of the allogeneic HSCT recipients. The median number of post transplant transfusions, percent transferrin saturation and ferritin levels were found to be higher in patients who had histologically proven hepatic IO (p1=0.007, p2=0.003 and p3=0.009, respectively). Regression analysis showed a significant correlation between serum ferritin levels and histological grade of iron in the hepatocytes. Our data suggest that hepatic IO is a frequent finding in the post-HSCT setting, which contributes to hepatic dysfunction and it should be considered in the differential diagnosis, particularly in patients with high serum ferritin levels.
Sucak
G T
GT
Department of Hematology, Faculty of Medicine, Gazi University, Ankara, Turkey. aysucak@gazi.edu.tr
Yegin
Z A
ZA
Ozkurt
Z N
ZN
Aki
S Z
SZ
Karakan
T
T
Akyol
G
G
D000328:Adult; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001706:Biopsy; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006689:Hodgkin Disease / Q000188:drug therapy / Q000601:surgery; D006801:Humans; D019190:Iron Overload / Q000209:etiology* / Q000469:parasitology; D007938:Leukemia / Q000188:drug therapy / Q000601:surgery; D008099:Liver / Q000473:pathology*; D008107:Liver Diseases / Q000209:etiology / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy / Q000601:surgery; D012189:Retrospective Studies; D014184:Transplantation, Homologous / Q000009:adverse effects; D055815:Young Adult
D000970:Antineoplastic Agents