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Wu J, Zhang X, Qin B, Qiu X, Zhang X, Zhang H, Du X, Sun L, Cai Y, Zhou J. Incidence, Etiology and Prognosis of Initial Liver Injury After Allogeneic Hematopoietic Stem Cell Transplantation: A Multi-Center Retrospective Study. Transplant Proc 2024:S0041-1345(24)00354-3. [PMID: 38972762 DOI: 10.1016/j.transproceed.2024.05.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Revised: 05/08/2024] [Accepted: 05/08/2024] [Indexed: 07/09/2024]
Abstract
BACKGROUND Liver injury post allogeneic hematopoietic stem cell transplantation (Allo-HSCT), particularly first-time occurrences, is a prevalent and severe complication. METHODS Clinical data from 262 patients treated at 3 medical centers in Shenzhen, China, between January 2018 and December 2021 were retrospectively collected. Risk factors and outcomes of initial liver injury post allo-HSCT were analyzed. RESULTS Liver injury occurred in 70.8% of patients, with drug-induced liver injury (DILI) being the most common cause. Other causes included graft-versus-host disease (GVHD) and veno-occlusive disease (VOD). Pre-transplant HBsAg positivity was a significant risk factor. Differences in the timing and survival outcomes were observed among patients with different causes and types of liver injury. Patients with VOD or hepatic aGVHD had lower overall survival compared to those with DILI or hepatic cGVHD. Patients with isolated enzyme elevation had a more favorable prognosis than those with isolated bilirubin elevation or simultaneous enzyme and bilirubin elevation. CONCLUSION Findings of our study serve as a crucial resource for clinicians, assisting in the challenging task of diagnosing and managing liver injuries after allo-HSCT, especially when it occurs for the first time, which may ultimately help to reduce early treatment-related mortality and enhance the long-term survival of transplant recipients.
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Affiliation(s)
- Jingsong Wu
- Department of Hematology, The Second Clinical Medical College, Jinan University, Shenzhen, China
| | - Xiaohan Zhang
- Department of Hematology, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
| | - Baozhen Qin
- Department of Hematology, Peking University Shenzhen Hospital, Shenzhen, China
| | - Xiao Qiu
- Department of Hematology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; the First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China
| | - Xinyou Zhang
- Department of Hematology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; the First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China
| | - Hongyu Zhang
- Department of Hematology, Peking University Shenzhen Hospital, Shenzhen, China
| | - Xin Du
- Department of Hematology, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
| | - Lihua Sun
- Department of Hematology, Peking University Shenzhen Hospital, Shenzhen, China.
| | - Yun Cai
- Department of Hematology, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China.
| | - Jihao Zhou
- Department of Hematology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; the First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China.
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Dezan MGF, Cavalcante LN, Silva HRC, de Moura Almeida A, Dos Santos de Assis LH, de Freitas TT, de Araújo MAS, Cotrim HP, Lyra AC. Hepatobiliary disease after bone marrow transplant: A cross-sectional study of 377 patients. Aliment Pharmacol Ther 2024; 59:71-79. [PMID: 37833826 DOI: 10.1111/apt.17756] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 08/03/2023] [Accepted: 09/28/2023] [Indexed: 10/15/2023]
Abstract
BACKGROUND Bone marrow transplantation (BMT) is a standard treatment for several haematologic conditions. Following BMT, patients may develop hepatobiliary complications that impact morbidity and mortality. The differential diagnosis may include drug-induced liver injury (DILI), sepsis-associated liver injury (SALI), sinusoidal obstruction syndrome (SOS), graft-versus-host disease (GVHD), viral hepatitis, ischaemic hepatitis, and fulminant hepatitis. AIMS To evaluate the frequency, clinical characteristics, and outcomes of patients with hepatobiliary alterations associated with BMT in a tertiary referral centre. METHODS This was a cross-sectional study with data collected from the medical records of patients undergoing BMT between January 2017 and June 2022. We diagnosed hepatobiliary complications based on established criteria. RESULTS We included 377 patients; 55.7% had hepatobiliary complications. Female gender, pre-BMT hepatobiliary alteration, and haploidentical allogeneic transplantation were associated with increased risk with odds ratios (OR) of 1.8 (p = 0.005), 1.72 (p = 0.013) and 3.25 (p = 0.003), respectively. Patients with hepatobiliary complications spent longer in the hospital than those without (27.7 × 19.3 days, respectively; p < 0.001). Among 210 patients with hepatobiliary complications, 28 died compared to 5 of 167 without complications (OR 4.98; p = 0.001). CONCLUSIONS Hepatobiliary complications are frequent in patients undergoing BMT. There is a greater risk of their occurrence in women, people with pre-BMT liver alterations, and in haploidentical transplants. The occurrence of these complications increases the length of stay and is associated with a higher risk of death.
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Affiliation(s)
- Maria Gabriela Fernandes Dezan
- Instituto D'Or de Pesquisa e Ensino (IDOR) and Hospital São Rafael-Gastro-Hepatology Service, Hospital São Rafael, Salvador, Bahia, Brazil
- Gastro-Hepatology Service-University Hospital Professor Edgard Santos (HUPES), Federal University of Bahia, Salvador, Bahia, Brazil
- Postgraduate Program in Medicine and Health, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Lourianne Nascimento Cavalcante
- Instituto D'Or de Pesquisa e Ensino (IDOR) and Hospital São Rafael-Gastro-Hepatology Service, Hospital São Rafael, Salvador, Bahia, Brazil
- Gastro-Hepatology Service-University Hospital Professor Edgard Santos (HUPES), Federal University of Bahia, Salvador, Bahia, Brazil
- Postgraduate Program in Medicine and Health, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Hugo Rodrigues Carvalho Silva
- Instituto D'Or de Pesquisa e Ensino (IDOR) and Hospital São Rafael-Hematology Service, Hospital São Rafael, Salvador, Bahia, Brazil
| | - Alessandro de Moura Almeida
- Instituto D'Or de Pesquisa e Ensino (IDOR) and Hospital São Rafael-Hematology Service, Hospital São Rafael, Salvador, Bahia, Brazil
- Hematology Service-University Hospital Professor Edgard Santos (HUPES), Federal University of Bahia, Salvador, Bahia, Brazil
| | | | - Tiago Thalles de Freitas
- Instituto D'Or de Pesquisa e Ensino (IDOR) and Hospital São Rafael-Hematology Service, Hospital São Rafael, Salvador, Bahia, Brazil
| | - Marco Aurélio Salvino de Araújo
- Postgraduate Program in Medicine and Health, Federal University of Bahia, Salvador, Bahia, Brazil
- Instituto D'Or de Pesquisa e Ensino (IDOR) and Hospital São Rafael-Hematology Service, Hospital São Rafael, Salvador, Bahia, Brazil
- Hematology Service-University Hospital Professor Edgard Santos (HUPES), Federal University of Bahia, Salvador, Bahia, Brazil
| | - Helma Pinchemel Cotrim
- Gastro-Hepatology Service-University Hospital Professor Edgard Santos (HUPES), Federal University of Bahia, Salvador, Bahia, Brazil
- Postgraduate Program in Medicine and Health, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Andre Castro Lyra
- Instituto D'Or de Pesquisa e Ensino (IDOR) and Hospital São Rafael-Gastro-Hepatology Service, Hospital São Rafael, Salvador, Bahia, Brazil
- Gastro-Hepatology Service-University Hospital Professor Edgard Santos (HUPES), Federal University of Bahia, Salvador, Bahia, Brazil
- Postgraduate Program in Medicine and Health, Federal University of Bahia, Salvador, Bahia, Brazil
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HBV Infection-Related PDZK1 Plays an Oncogenic Role by Regulating the PI3K-Akt Pathway and Fatty Acid Metabolism and Enhances Immunosuppression. J Immunol Res 2022; 2022:8785567. [PMID: 36052278 PMCID: PMC9427290 DOI: 10.1155/2022/8785567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 07/15/2022] [Indexed: 11/18/2022] Open
Abstract
Background and Aim. Chronic hepatitis B virus (HBV) infection is the leading global cause of hepatocellular carcinoma (HCC). Few studies have been conducted concerning the HBV infection-related genes and their function. Methods. We compared differentially expressed genes (DGEs) in HBV-positive and -negative tumor samples and conducted a Spearman correlation study between the DGEs and HBV titers within The Cancer Genome Atlas (TCGA). Moreover, we validated the results of our in-house samples. Results. In this study, we discovered a series of genes that correlated statistically with HBV infection based on the TCGA database. These genes were related to increased inflammation and some oncogenic signaling pathways via Gene Set Enrichment Analysis (GSEA). PDZK1 is an ideal gene, which mostly relates positively to HBV infection; moreover, it is overexpressed in human HCC, especially in those HBV-infected HCCs. After analyzing the TCGA data and performing a verification study using our own samples, PDZK1 expression was investigated to be significantly associated with PI3K-Akt signaling and fatty acid metabolism. Further, single-sample GSEA analysis of tumor immune cell infiltration gene sets revealed that high PDZK1expression in HCC tissues was significantly associated with increased tumor-associated macrophages (TAMs) and regulatory T cells(Tregs). Conclusions. PDZK1 is an HBV infection-related gene, which plays oncogenic roles, possibly due to enhancing PI3K-Akt, fatty acid usage in tumor cells and TAMs, and Treg-induced immunosuppression.
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