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Post-Transplant Events

Incidence, characteristics and risk factors of marked hyperbilirubinemia after allogeneic hematopoietic cell transplantation with reduced-intensity conditioning

Bone Marrow Transplantation volume 47, pages 1343–1349 (2012)Cite this article

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Abstract

To analyze the incidence, characteristics and risk factors of hyperbilirubinemia after allogeneic hematopoietic cell transplantation with reduced-intensity conditioning (allo-RIC), we conducted a retrospective study in three Spanish centers. We analyzed 452 consecutive patients receiving allo-RIC. Of these, 92 patients (20%) developed marked hyperbilirubinemia (>4 mg/day or >68.4 μM) after allo-RIC. The main causes of marked hyperbilirubinemia after transplant were cholestasis due to GVHD or sepsis (n=57, 62%) and drug-induced cholestasis (n=13, 14%). A total of 22 patients with marked hyperbilirubinemia (24%) underwent liver biopsy. The most frequent histological finding was iron overload alone (n=6) or in combination with other features (n=6). In multivariate analysis, the risk factors for marked hyperbilirubinemia after allo-RIC were non-HLA-identical sibling donors (hazard ratio (HR) 2.2 (95% confidence interval (CI) 1.4–3.6) P=0.001), female donors to male recipients (HR 2.1 (95% CI 1.3–3.3) P=0.003) and high levels of bilirubin and γ-glutamyl transpeptidase before transplant (HR 4.5 (95% CI 2.5–8.4) P<0.001 and HR 4.6 (95% CI 2.6–8.1) P<0.001, respectively). Patients with marked hyperbilirubinemia showed higher 4-year nonrelapse mortality (HR 1.3 (95% CI 1–1.7), P=0.02) and lower 4-year OS (HR 1.4 (95%CI 1.3–1.7), P<0.001) than patients without. In conclusion, we confirm that marked hyperbilirubinemia is frequent and diverse after allo-RIC. Development of marked hyperbilirubinemia after allo-RIC is associated with worse outcome of the procedure.

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Acknowledgements

JL Piñana is supported by grant from the Instituto de Salud Carlos III (CM06/00139, Ministerio de Sanidad, Spain). This study was supported in part by Grant RD06/0020/0101 from the Instituto de Salud Carlos III, Ministerio de Sanidad, Spain, and from the Fundació d’Investigació Sant Pau (Ferrer-Salat Award).

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  1. P Barba, J A Perez-Simón, J L Piñana and D Valcárcel: Current center

Authors and Affiliations

  1. Department of Hematology, Hospital de la Santa Creu i Sant Pau de Barcelona, Barcelona, Spain

    P Barba, R Martino, J L Piñana, D Valcárcel, S Novelli & J Sierra

  2. Division of Clinical Hematology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain

    P Barba & D Valcárcel

  3. Hospital Clinico Salamanca, Spain

    J A Perez-Simón, L Lopez-Anglada & L Lopez-Corral

  4. Hospital Universitario Virgen del Rocío/IBIS, Sevilla, Spain

    J A Perez-Simón

  5. Hospital Clínico, Barcelona, Spain

    F Fernández-Avilés, M Rovira & E Carreras

  6. Hospital de Manises, Valencia, Spain

    J L Piñana

  7. Department of Internal Medicine, Liver Unit, Hospital Universitario Vall d'Hebron, Centro de Investigación Biomedica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Universidad Autónoma de Barcelona, Barcelona, Spain

    I Campos-Varela

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Barba, P., Martino, R., Perez-Simón, J. et al. Incidence, characteristics and risk factors of marked hyperbilirubinemia after allogeneic hematopoietic cell transplantation with reduced-intensity conditioning. Bone Marrow Transplant 47, 1343–1349 (2012). https://doi.org/10.1038/bmt.2012.25

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