الفهرس 
Stem Cell TransplantationOnly 14 pages are availabe for public view
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Abstract
Haematopoietic stem cell transplantation is now a corner stone in treatment of hematological disease, hepatic complications count for a significant part of morbidity and mortality during and after HSCT.
Patients being prepared for hematopoietic cell transplantation should must be evaluated for liver-related complications to improve the HSCT results
Early complications include drug-induced liver toxicty, infectious, sinusoidal obstruction syndrome, and graft versus-host disease (the last two are mainly happen in allogenic HSCT), late complications may be cirrhosis, and hepatic cancers and chronic graft versus-host disease in allogenic HSCT
Hepatic GVHD is very common hepatic complications post allogenic HSCT, it could be acute or chronic
Acute GVHD involves liver, gastrointestinal system, skin and mucosal surfaces.
Chronic GVHD develops 2-12 months after HSCT and involves the skin, eyes, mouth, liver, fascia, and almost any organ in the body.
Liver involvement is characterized by progressive elevation of all liver function tests; the rise in conjugated bilirubin and alkaline phosphatase are the most common and earliest findings. The diagnosis of hepatic GVHD depend on clinical presentations and histopathlogical examination after liver biopsy but liver biopsy is invasive technique and sometimes non feasible
Non-invasive method which measures liver stiffness, Liver stiffness measurement allowed accurate prediction of hepatic fibrosis in patients with liver disease
Acoustic radiation force impulse Acoustic radiation force impulse (ARFI) imaging is a radiation force-based imaging method that is provided by conventional B-mode ultrasonography), its reliable methods for assessing fibrosis. staging of liver disease in patients with chronic liver disease.
We started our study on 40 that subdivided into two groups: group (I):30 patients that performed allogenic HSCT
The patients followed up prospectively for more than 6 months
this group did baseline ARFI pretransplant and follow up by it at 3 months and 6 months but during the study 9 patients died and cant be follow-uped by ARFI at 6 months so we did ARFI at 6 months for 21 patients remain alive at that time (group Ib).
group (II): 10 old patients did allogenic HSCT from more than one year and developed chronic hepatic GVHD proved by liver biopsy (group II) did ARFI at the time of liver biopsy. Those patients followed up both prospectively and retrospectively and collect pretransplant data from their files
group (III):Group(Ib)+Group(II) as both groups showed the incidence of chronic hepatic GVHD
There was no statistically significant difference between pretransplant ARFI and patients age, sex diagnosis and viral serology and pretransplant hepatic comorbidity index of group I
There was statistically significant difference between ARFI score pre transplant and Hepatic Radiological investigation (ultrasound) of group I
There was highly statistically significant difference between ARFI score and ARFI stiffness pre transplant and PCR of HBV of group I
There was statistically significant difference between acute hepatic GVHD status with hepatic comorbidity index score pre transplant in group I there was difference between acute GVHD and ARFI stiffness pre transplant in group I but yet not statistically significant
There was no statistically significant difference between ARFI score with liver biopsy in group I, there no statistically significant difference this may be due to low number of patients did liver biopsy at this time
Post transplant by 3months,when comparing between acute hepatic GVHD and both ARFI score and ARFI stiffness, there were statistically significant difference 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
As regard comparison between acute hepatic GVHD and Hepatic comorbidity index score post transplant after 3 months in group I, there was statistically significant difference as acute hepatic GVHD is associated with increase comorbidity index score
As regard chronic hepatic GVHD 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 between CMV PCR reactivation after 6 months of transplantand chronic hepatic GVHD of group (III) that mean that CMV infection or reactivation is risk factor for chronic GVHD
There was statistically significant difference between patients clinically diagnosed chronic GVHD and liver biopsy done after 6 months in group (Ib)
There was statistically significant difference between grade of chronic hepatic GVHD for group (Ib) and ARFI stiffness post transplant after 3 months
After 6 months, only 11 patients out of 21 in group Ib developed chronic hepatic GVHD and liver biopsy done for them and prove that, we found statistically significant difference between ARFI score and stiffness post transplant after 6 months and Liver biopsy as 10 patients had F2-F4 (69,2%) and one patient had F0-F1which mean that patients developed chronic hepatic GVHD have high liver stiffness that can detected by ARFI and has high sensitivity as liver biopsy for diagnosis no statistically significant difference between grade of chronic hepatic GVHD of group II and pretransplant, during transplant and posttransplant data
And no statistically significant between ARFI and its stiffness and data post transplant more than one year, it may be due to low number of patients in this group
So we made new group by group Ib + group II and called it group III and it show highly statistically significant difference between chronic hepatic GVHD and CMV reactivation post transplant and liver biopsy in chronic duration.
And we conclude from the study that the ARFI score and stiffness increase with acute and chronic hepatic GVHD with significant correlation between histological fibrosis by liver biopsy and ARFI measurement so ARFI could be non invasive technique for the early diagnosis of hepatic GVHD specially if liver biopsy is not feasible.