title: Risk factors and prognosis of hepatic acute GvHD after allogeneic hematopoietic cell transplantation.
abstract: Hepatic acute GvHD (aGvHD) is associated with high mortality owing to poor response to immunosuppressive therapy. The pathogenesis of hepatic aGvHD differs from that of other lesions, and specific risk factors related to pre-transplant liver conditions should be determined. We conducted a cohort study by using a Japanese transplant registry database (N=8378). Of these subjects, 1.5% had hepatitis C virus Ab (HCV-Ab) and 9.4% had liver dysfunction (elevated transaminase or bilirubin levels) before hematopoietic cell transplantation (HCT). After HCT, the cumulative incidence of hepatic aGvHD was 6.7%. On multivariate analyses, HCV-Ab positivity (hazard ratio (HR), 1.93; P=0.02) and pre-transplant liver dysfunction (HR, 1.85; P<0.01), as well as advanced HCT risk, unrelated donors, HLA mismatch and cyclosporine as GvHD prophylaxis, were significant risk factors for hepatic aGvHD, whereas hepatitis B virus surface Ag was not. Hepatic aGvHD was a significant risk factor for low overall survival and high transplant-related mortality in all aGvHD grades (P<0.01). This study is the first to show the relationship between pre-transplant liver conditions and hepatic aGvHD. A prospective study is awaited to validate the results of this study and establish a new strategy especially for high-risk patients.
authors.affiliation: Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Arai
authors.affiliation: Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
authors.forename: J
authors.initials: J
authors.lastname: Kanda
authors.affiliation: Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan.|Division of Blood and Marrow Transplantation, School of Medicine, Stanford University, California, USA.
authors.forename: H
authors.initials: H
authors.lastname: Nakasone
authors.affiliation: Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Kondo
authors.affiliation: Department of Hematology, Federation of National Public Service Personnel Mutual Aid Associations Toranomon Hospital, Tokyo, Japan.
authors.forename: N
authors.initials: N
authors.lastname: Uchida
authors.affiliation: Division of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Fukuda
authors.affiliation: Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Ohashi
authors.affiliation: Division of Hematology, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Kaida
authors.affiliation: Department of Hematology, Hiroshima Red Cross Hospital & Atomic-bomb Survivors Hospital, Hiroshima, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Iwato
authors.affiliation: Department of Hematology, Hamanomachi Hospital, Fukuoka, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Eto
authors.affiliation: Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Kanda
authors.affiliation: Department of Hematology, Osaka City University, Osaka, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Nakamae
authors.affiliation: Department of Cell Processing and Transfusion, Research Hospital, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Nagamura-Inoue
authors.affiliation: Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Aichi, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Morishima
authors.affiliation: Department of General Internal Medicine and Clinical Laboratory Medicine, Graduate School of Medicine, Akita University, Akita, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Hirokawa
authors.affiliation: Japanese Data Center for Hematopoietic Cell Transplantation, Aichi, Japan.|Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Aichi, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Atsuta
authors.affiliation: Department of Hematology and Oncology, Nagoya University Graduate School of Medicine, Aichi, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Murata
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D064591:Allografts; D016572:Cyclosporine / Q000008:administration & dosage / Q000009:adverse effects; D018572:Disease-Free Survival; D005260:Female; D006086:Graft vs Host Disease / Q000097:blood / Q000188:drug therapy / Q000209:etiology / Q000401:mortality; D019337:Hematologic Neoplasms / Q000097:blood / Q000401:mortality / Q000628:therapy; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008107:Liver Diseases / Q000097:blood / Q000188:drug therapy / Q000209:etiology / Q000401:mortality; D008297:Male; D008875:Middle Aged; D012042:Registries; D012307:Risk Factors; D015996:Survival Rate
chemical_list: D016572:Cyclosporine