Severe hepatocellular injury after hematopoietic cell transplant: incidence, etiology and outcome

ABSTRACT Hepatic complications of transplant are a common cause of mortality. Although mild elevations of serum aminotransferase enzymes (aspartate and alanine (AST, ALT)) do not carry an

adverse prognosis, this is not the case with severe hepatocellular injury. We reviewed 6225 consecutive recipients to determine the incidence and outcomes of severe hepatocellular injury

(AST >1500 U/l) before day 100, which occurred in 88 patients. Causes were sinusoidal obstruction syndrome (SOS) (_n_=46), hypoxic hepatitis (_n_=33), varicella zoster virus (VZV)

hepatitis (_n_=4), drug-liver injury (_n_=2) and unknown (_n_=3). The incidence declined from 1.9% in the 1990s to 1.1% recently (owing to a fivefold decline in SOS and disappearance of VZV

hepatitis). In hypoxic hepatitis, peak serum AST was 3545 U/l (range, 1380–25 246) within days of shock or prolonged hypoxemia; case fatality rate was 88%. In SOS, AST increases occurred 2–6

weeks after diagnosis; peak AST was 2252 U/l (range, 1437–8281); case fatality rate was 76%, with only serum bilirubin able to distinguish survivors (2.7 vs 11.3 mg/100 ml, _P_=0.0009). We

conclude that circulatory insults (sinusoidal injury, hypotension and hypoxemia), and not infection, are the most common cause of severe hepatocellular injury, the frequency of which has

declined because of a falling incidence of SOS and VZV hepatitis. Access through your institution Buy or subscribe This is a preview of subscription content, access via your institution

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TRANSPLANTATION IS ASSOCIATED WITH INCREASED RISK OF POST-TRANSPLANT COMPLICATIONS AND POOR TRANSPLANT OUTCOMES Article 25 June 2022 LOW INCIDENCE OF HEPATIC SINUSOIDAL OBSTRUCTION

SYNDROME/VENO-OCCLUSIVE DISEASE IN ADULTS UNDERGOING ALLOGENIC STEM CELL TRANSPLANTATION WITH PROPHYLACTIC URSODIOL AND LOW-DOSE HEPARIN Article Open access 04 January 2022 UTILITY OF THE

REFINED EBMT DIAGNOSTIC AND SEVERITY CRITERIA 2023 FOR SINUSOIDAL OBSTRUCTION SYNDROME/VENO-OCCLUSIVE DISEASE Article Open access 29 January 2024 REFERENCES * Strasser SI, McDonald GB .

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ACKNOWLEDGEMENTS Our research in the field of gastrointestinal and hepatobiliary complications of hematopoietic cell transplant is supported by grants from the US National Institutes of

Health, National Cancer Institute (CA 18029, CA 15704). Dr Sakai is supported by funding from the Bureau of Social Welfare and Public Health of the Tokyo Metropolitan Government and the

Japan Clinical Research Support Unit. AUTHOR INFORMATION AUTHORS AND AFFILIATIONS * Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA M Sakai, H M Shulman,

 S J McDonald, H G Schoch & G B McDonald * AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia S I Strasser * Department of

Medicine, University of Washington School of Medicine, Seattle, WA, USA H M Shulman & G B McDonald Authors * M Sakai View author publications You can also search for this author inPubMed

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THIS ARTICLE CITE THIS ARTICLE Sakai, M., Strasser, S., Shulman, H. _et al._ Severe hepatocellular injury after hematopoietic cell transplant: incidence, etiology and outcome. _Bone Marrow

Transplant_ 44, 441–447 (2009). https://doi.org/10.1038/bmt.2009.56 Download citation * Received: 07 November 2008 * Revised: 29 January 2009 * Accepted: 07 February 2009 * Published: 23

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link Sorry, a shareable link is not currently available for this article. Copy to clipboard Provided by the Springer Nature SharedIt content-sharing initiative KEYWORDS * hepatocellular

injury * sinusoidal obstruction syndrome * viral hepatitis * hematopoietic cell transplant * hypoxic hepatitis * outcomes