title: Pretransplantation liver function impacts on the outcome of allogeneic hematopoietic stem cell transplantation: a study of 455 patients.
abstract: Liver dysfunction is frequent before allogeneic stem cell transplantation (allo-SCT). However, its characteristics and impact on transplantation outcomes are uncertain, especially in the reduced-intensity conditioning (RIC) setting. We analyzed 455 patients receiving an allo-SCT in 3 Spanish centers. Pretransplantation aspartate aminotransferase (AST), alanine aminotransaminase (ALT), gamma-glutamyl transpeptidase (GGT), alkaline phosphatase (AP), total bilirubin, and international normalized ratio were analyzed. Pretransplantation liver function test abnormalities were found in 94 (22%) patients. The most frequent cause of pretransplantation liver dysfunction was isolated elevation of GGT/AP (n = 49, 53%). Patients with high bilirubin levels before allo-SCT showed higher 4-year nonrelapse mortality (4y-NRM) (hazard ratio [HR] 2 [95% confidence interval [CI] 1.1-3.8] P = .02) and patients with high GGT levels showed higher 100-day NRM and lower 4-year overall survival (OS) (HR 3.4 [95% CI 1.8-6.7] P < .001, and HR 2 [95% CI 1.4-3], P = .001), respectively. High levels of transaminases did not influence on survival or mortality. In conclusion, hepatic dysfunction before allo-SCT is frequent and has an impact on transplantation outcomes. The best indicator of liver dysfunction still has to be determined.
authors.affiliation: Hematology Departments of Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona and Universitat Autònoma de Barcelona, Mas Casanovas 90, Barcelona, Spain. pebarba@vhebron.net
authors.forename: Pere
authors.initials: P
authors.lastname: Barba
authors.forename: José Luis
authors.initials: JL
authors.lastname: Piñana
authors.forename: Francesc
authors.initials: F
authors.lastname: Fernández-Avilés
authors.forename: Jose Antonio
authors.initials: JA
authors.lastname: Perez-Simón
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Martino
authors.forename: Eva
authors.initials: E
authors.lastname: López-Guerrero
authors.forename: David
authors.initials: D
authors.lastname: Valcárcel
authors.forename: Montserrat
authors.initials: M
authors.lastname: Rovira
authors.forename: Silvana
authors.initials: S
authors.lastname: Novelli
authors.forename: Isabel
authors.initials: I
authors.lastname: Campos-Varela
authors.forename: Lucía
authors.initials: L
authors.lastname: López-Anglada
authors.forename: Xavier
authors.initials: X
authors.lastname: Vidal
authors.forename: Lucía
authors.initials: L
authors.lastname: López Corral
authors.forename: Enric
authors.initials: E
authors.lastname: Carreras
authors.forename: Jorge
authors.initials: J
authors.lastname: Sierra
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D008099:Liver / Q000503:physiopathology*; D008111:Liver Function Tests / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D019172:Transplantation Conditioning / Q000379:methods*; D014184:Transplantation, Homologous / Q000009:adverse effects; D016896:Treatment Outcome; D055815:Young Adult