الفهرس 
STEM CELL TRANSPLANTATIONOnly 14 pages are availabe for public view
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Abstract
Background:Hepatic injury is a frequent complication of hematopoietic SCT and carries a high risk for early morbidity and mortality. hepatic complications include drug toxicity, veno-occlusive disease, acute and chronic GVHD, and infection:.
Aim of the work: Assessment of Liver Damage and toxicity with Acoustic radiation force impulse (ARFI) in Egyptian patients post allogeneic hemopoietic stem cell transplantion(SCT) and relation to development of hepatic GVHD.
Patients and methods: - Acoustic radiation force impulse (ARFI) score and stiffness performed pretransplant, at 3 months for 30 patients that received allogenic HSCT (group I) and at 6 months for 21 patients only (group Ib) they followed up prospectively . (ARFI) score and stiffness done for 10 patients received allogenic HSCT for more than one year and proved to have chronic hepatic GVHD clinically,laboratory and by liver biopsy and those patients were followed up both prospectively and retrospectively as their were collected from their files. ALL patients were recruited from transplantion unit at Ain shams university hospital over the period from April 2017 to October 2018.
Results: ARFI score and ARFI stiffness, there were statistically significant differences with acute hepatic GVHD as low score and low stiffness were in cases with negative acute hepatic GVHD while high score >2 and high stiffness were in cases with acute hepatic GVHD(p=0.02,0.003 respectively), acute hepatic GVHD is associated with increase comorbidity index score post transplant by 3 months, there was statistically significant difference between CMV PCR reactivation after 6 months of transplant and grade of chronic hepatic GVHD for group (Ib) and highly significant difference between CMV PCR reactivation after 6 months of transplant and chronic hepatic GVHD of group (III), There was statistically significant difference between grade of chronic hepatic GVHD and ARFI score post transplant by 6 months in group (Ib) as all patients with grade 2 and 3 GVHD had F0-F1 ARFI score (10%),while 2 patients out of 4 GVHD cases of grade 4 had F2-F4 ARFI score (50%), Moreover there were statistically significant differences between chronic hepatic GVHD for group (Ib) and both ARFI score and stiffness post transplant by 6 months as 10 patients developed chronic hepatic GVHD had F2-F4 ARFI score (83%) while 2 were(F0-F1) with stiffness mean 1.45 ± 0.32, statistically significant difference between ARFI score and stiffness post transplant after 6 months and Liver biopsy as 10 patients had F2-F4 ARFI score (69,2%) and one patient had F0-F1 score,which mean that patients developed chronic hepatic GVHD have high ARFI score and stiffness and this could be as sensitivite as liver biopsy for diagnosis,), there were no statistically significant differences between ARFI score and stiffness and data post transplant more than one year,it may be due to small number of patients in this group
Trying to investigate better chronic hepatic GVHD cases,we added both group Ib and group II as both group shared the incidence of chronic hepatic GVHD group (III), it showed highly statistically significant difference between chronic hepatic GVHD and CMV reactivation post transplant and liver biopsy and show difference between chronic hepatic GVHD and hepatic comorbidity index but not statistically significant yet (p=0.005).
Conclusion: ARFI score and stiffness are significantly increased post transplant with the incidence of acute and chronic hepatic Graft-versus-host disease and there is a statistically significant correlation between histological fibrosis by liver biopsy and ARFI measurements, So ARFI could be a reliable non-invasive technique for the early diagnosis of hepatic GVHD specially if liver biopsy is not feasible.