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Non-invasive transient elastography for the prediction of liver toxicity following hematopoietic SCT

Bone Marrow Transplantation volume 48, pages 159–160 (2013)Cite this article

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Hepatic injury is a frequent complication of hematopoietic SCT and carries a high risk for early morbidity and mortality. Early hepatic complications include drug toxicity, veno-occlusive disease, acute GVHD, infection and cholestatic disorders.1 Risk evaluation for hepatic complications should begin in the pre transplant period with the identification of risk factors that may be associated with development of hepatic dysfunction post-transplant, such as viral hepatitis status or elevated liver enzymes before the start of conditioning. Transient elastography (FibroScan) is a non-invasive and reproducible method for the assessment of hepatic fibrosis in patients with chronic liver disease by measuring liver stiffness (LS).2, 3 LS is also a surrogate marker for significant necroinflammation or extrahepatic cholestasis in the absence of fibrosis. TE has been assessed in chronic hepatitis B, hepatitis C, co-infection with HIV, non-alcoholic fatty liver disease, primary biliary cirrhosis and primary sclerosing cholangitis, and it also has been validated for evaluation of fibrosis in the post-liver transplant setting.4, 5

The primary aim of the current single-center analysis was to evaluate whether the use of pre transplant non-invasive transient elastography might be predictive for post-transplant liver toxicity. We therefore incorporated the investigation into our routine pre transplant work-up program. All patients gave written informed consent. Patient characteristics are summarized in Table 1. Conditioning regimens for Auto-SCT were CY (total dose 120 mg/kg) in combination with fractionated TBI (12 gray) or i.v. BU (total dose 12.8 mg/kg) for acute leukemia (n=2), BEAM for lymphoma (n=16), high-dose melphalan (total dose 200 mg/kg) for plasma cell disorders (n=14) and i.v. BU (total dose 12.8 mg/kg) with high-dose melphalan (total dose 140 mg/kg) for solid tumors (n=4). For allo-SCT-conditioning the regimen consisted of standard-dose BUCY or BUMEL (n=16) or CY (total dose 120 mg/kg) ±VP-16 (total dose 20–40 mg/kg) and fractionated TBI (12 Gy) (n=2) for myeloablative transplants and mainly BU (total dose 6.4–12.8 mg/kg)—FLU (total dose 90 mg/kg)-based regimen for dose-reduced transplants (n=12). Statistical analyses were completed using using GraphPad Prism 4.0 (GraphPad Software, Inc., San Diego, CA, USA) with a 5% level of significance.

Table 1 Patient characteristics
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Authors and Affiliations

  1. University Hospital of Internal Medicine V, Hematology and Oncology, Innsbruck Medical University, Innsbruck, Austria

    J Auberger, J Clausen & D Nachbaur

  2. Department of Internal Medicine III with Hematology, Oncology, Infectious Diseases, Hemostaseology and Rheumatology, Paracelsus Private Medical University, Salzburg, Austria

    J Auberger & J Clausen

  3. University Hospital of Internal Medicine II, Gastroenterology and Hepatology, Innsbruck, Medical University, Innsbruck, Austria

    I Graziadei & W Vogel

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  1. J Auberger
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  2. I Graziadei
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Correspondence to J Auberger.

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Auberger, J., Graziadei, I., Clausen, J. et al. Non-invasive transient elastography for the prediction of liver toxicity following hematopoietic SCT. Bone Marrow Transplant 48, 159–160 (2013). https://doi.org/10.1038/bmt.2012.113

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