[The influence of liver dysfunction before transplantation and during conditioning period on the outcome of allogeneic hematopoietic stem cell transplantation].
OBJECTIVE
To investigate the characteristics of liver dysfunction pre-transplant and during conditioning period and its impacts on transplantation related hepatic complication, overall survival (OS) and transplant-related mortality (TRM).


METHODS
A total of 196 patients undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT) at Peking University First Hospital were analyzed retrospectively. Liver function test for each patient was examined pre-transplant and during the period of conditioning. The correlation of liver dysfunction with hepatic complications, OS and TRM rates were analyzed.


RESULTS
Liver dysfunction before transplantation was found in 38 (19.8%, 38/192) patients, while damage of liver function during conditioning was found in 159(81.1%) patients, 28 of whom developed grade 3 hepatic dysfunction. There was no life-threatening impairment of liver function. No matter pre-transplant or during conditioning, liver dysfunction did not suggest apparent influence on the engraftment of neutrophil or platelet or the incidence of hepatic complications including hepatic veno occlusive disease (HVOD), acute graft versus host disease (aGVHD) and chronic graft versus host disease (cGVHD). Univariate analysis revealed that factors affecting OS rate included age (P = 0.022), high risk stage (P = 0.003), AST and TBil elevation before transplantation (P = 0.019 and 0.015 respectively), III-IV hepatic aGVHD (P = 0.000) and HVOD(P = 0.000). Multivariate Cox regression analysis revealed that high risk stage (P = 0.002) and III-IV hepatic aGVHD (P = 0.000) were independent prognostic risk factors affecting both OS rate and TRM rate, while liver dysfunction before transplantation or during conditioning period had no apparent influence on OS rate or TRM rate.


CONCLUSIONS
Allo-HSCT would be administrated for the patients with mild impairment of liver function grade 1 and 2.
Department of Hematology, Peking University First Hospital, Beijing 100034, China.
Jun
J
Zhao
Department of Hematology, Peking University First Hospital, Beijing 100034, China. Email: renhy0813@163.com.
Hanyun
H
Ren
Department of Hematology, Peking University First Hospital, Beijing 100034, China.
Zhixiang
Z
Qiu
Department of Hematology, Peking University First Hospital, Beijing 100034, China.
Mangju
M
Wang
Department of Hematology, Peking University First Hospital, Beijing 100034, China.
Wei
W
Liu
Department of Hematology, Peking University First Hospital, Beijing 100034, China.
Weilin
W
Xu
Department of Hematology, Peking University First Hospital, Beijing 100034, China.
Yuan
Y
Li
Department of Hematology, Peking University First Hospital, Beijing 100034, China.
Yuhua
Y
Sun
Department of Hematology, Peking University First Hospital, Beijing 100034, China.
Lihong
L
Wang
Department of Hematology, Peking University First Hospital, Beijing 100034, China.
Zeyin
Z
Liang
Department of Hematology, Peking University First Hospital, Beijing 100034, China.
Yujun
Y
Dong
Department of Hematology, Peking University First Hospital, Beijing 100034, China.
Jinping
J
Ou
Department of Hematology, Peking University First Hospital, Beijing 100034, China.
Wensheng
W
Wang
Department of Hematology, Peking University First Hospital, Beijing 100034, China.
Yue
Y
Yin
Department of Hematology, Peking University First Hospital, Beijing 100034, China.
Xinan
X
Cen
Department of Hematology, Peking University First Hospital, Beijing 100034, China.
Qian
Q
Wang
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D048550:Hepatic Insufficiency; D006801:Humans; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D055815:Young Adult