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Wang YM, Kaj-Carbaidwala B, Lane A, Agarwal S, Beier F, Bertuch A, Borovsky KA, Brennan SK, Calado RT, Catto LFB, Dufour C, Ebens CL, Fioredda F, Giri N, Gloude N, Goldman F, Hertel PM, Himes R, Keel SB, Koura DT, Kratz CP, Kulkarni S, Liou I, Nakano TA, Nastasio S, Niewisch MR, Penrice DD, Sasa GS, Savage SA, Simonetto DA, Ziegler DS, Miethke AG, Myers KC. Liver disease and transplantation in telomere biology disorders: An international multicenter cohort. Hepatol Commun 2024; 8:e0462. [PMID: 38896081 PMCID: PMC11186813 DOI: 10.1097/hc9.0000000000000462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 03/08/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND Patients with telomere biology disorders (TBD) develop hepatic disease, including hepatitis, cirrhosis, and hepatopulmonary syndrome. No specific treatment exists for TBD-related liver disease, and the role of liver transplantation (LT) remains controversial. Our study objectives were to describe the clinical characteristics, management, and outcomes in patients with TBD-related liver disease, and their LT outcomes. METHODS Data from 83 patients with TBD-associated liver disease were obtained from 17 participating centers in the Clinical Care Consortium of Telomere-Associated Ailments and by self-report for our retrospective, multicenter, international cohort study. RESULTS Group A ("Advanced") included 40 patients with advanced liver disease. Of these, 20 underwent LT (Group AT). Group M ("Mild") included 43 patients not warranting LT evaluation, none of whom were felt to be medically unfit for liver transplantation. Supplemental oxygen requirement, pulmonary arteriovenous malformation, hepatopulmonary syndrome, and higher bilirubin and international normalized ratio values were associated with Group A. Other demographics, clinical manifestations, and laboratory findings were similar between groups. Six group A patients were declined for LT; 3 died on the waitlist. Median follow-up post-LT was 2.9 years (range 0.6-13.2 y). One-year survival post-LT was 73%. Median survival post-LT has not been reached. Group AT patients had improved survival by age compared to all nontransplant patients (log-rank test p = 0.02). Of 14 patients with pretransplant hypoxemia, 8 (57%) had improved oxygenation after transplant. CONCLUSIONS LT recipients with TBD do not exhibit excessive posttransplant mortality, and LT improved respiratory status in 57%. A TBD diagnosis should not exclude LT consideration.
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Affiliation(s)
- YunZu Michele Wang
- Division of Bone Marrow Transplantation and Immune Deficiency, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Batul Kaj-Carbaidwala
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Lurie Children’s Hospital, Chicago, Illinois, USA
| | - Adam Lane
- Division of Bone Marrow Transplantation and Immune Deficiency, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Suneet Agarwal
- Department of Pediatrics, Division of Hematology/Oncology, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - Fabian Beier
- Department of Hematology and Oncology, University Klinik Aachen, Aachen, Germany
| | - Alison Bertuch
- Department of Pediatric Hematology-Oncology, Texas Children’s Hospital, Houston, Texas, USA
| | - Kristin A. Borovsky
- Department of Gastroenterology, Hepatology, and Nutrition, Texas Children’s Hospital, Houston, Texas, USA
| | - Steven K. Brennan
- Department of Pediatrics, Division of Allergy and Pulmonary Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Rodrigo T. Calado
- Department of Hematology and Oncology, University of Sao Paulo, Sao Paulo, Brazil
| | | | - Carlo Dufour
- Hematology Unit. IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Christen L. Ebens
- Division of Pediatric Blood and Marrow Transplant & Cellular Therapy, University of Minnesota, Minneapolis, MN, USA
| | | | - Neelam Giri
- Department of Pediatrics, Clinical Genetics Branch, National Cancer Institute, Bethesda, Maryland, USA
| | - Nicholas Gloude
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Rady Children’s Hospital San Diego, San Diego, California, USA
| | - Frederick Goldman
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, University of Alabama Birmingham, Birmingham, Alabama, USA
| | - Paula M. Hertel
- Department of Gastroenterology, Hepatology, and Nutrition, Texas Children’s Hospital, Houston, Texas, USA
| | - Ryan Himes
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Ochsner Health, New Orleans, Louisiana, USA
| | - Sioban B. Keel
- Department of Hematology, University of Washington, Seattle, Washington, USA
| | - Divya T. Koura
- Division of Hematology-Oncology and Bone Marrow Transplantation, Department of Medicine, University of California, San Diego, San Diego, California, USA
| | - Christian P. Kratz
- Department of Pediatric Hematology and Oncology, Hannover Medical School, Hannover, Germany
| | - Sakil Kulkarni
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Iris Liou
- Division of Gastroenterology, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Taizo A. Nakano
- Center for Cancer and Blood Disorders, Children’s Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Silvia Nastasio
- Department of Gastroenterology/Hepatology, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - Marena R. Niewisch
- Department of Hematology, Giannina Gaslini Institute, Genoa, Italy
- Division of Hematology-Oncology and Bone Marrow Transplantation, Department of Medicine, University of California, San Diego, San Diego, California, USA
| | - Daniel D. Penrice
- Department of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Ghadir S. Sasa
- Sarah Cannon Transplant and Cellular Therapy Network, San Antonio, Texas, USA
| | - Sharon A. Savage
- Department of Hematology, Giannina Gaslini Institute, Genoa, Italy
| | - Douglas A. Simonetto
- Department of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - David S. Ziegler
- School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Kensington, NSW, Australia
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Alexander G. Miethke
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Kasiani C. Myers
- Division of Bone Marrow Transplantation and Immune Deficiency, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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Sidali S, Borie R, Sicre de Fontbrune F, El Husseini K, Rautou PE, Lainey E, Goria O, Crestani B, Cadranel J, Cottin V, Bunel V, Dumortier J, Jacquemin E, Reboux N, Hirschi S, Bourdin A, Meszaros M, Dharancy S, Hilaire S, Mallet V, Reynaud-Gaubert M, Terriou L, Gottrand F, Abou Chahla W, Khan JE, Carrier P, Saliba F, Rubbia-Brandt L, Aubert JD, Elkrief L, de Lédinghen V, Abergel A, Olivier T, Houssel P, Jouneau S, Wemeau L, Bergeron A, Leblanc T, Ollivier-Hourmand I, Nguyen Khac E, Morisse-Pradier H, Ba I, Boileau C, Roudot-Thoraval F, Vilgrain V, Bureau C, Nunes H, Naccache JM, Durand F, Francoz C, Roulot D, Valla D, Paradis V, Kannengiesser C, Plessier A. Liver disease in germline mutations of telomere-related genes: Prevalence, clinical, radiological, pathological features, outcome, and risk factors. Hepatology 2024; 79:1365-1380. [PMID: 37934624 DOI: 10.1097/hep.0000000000000667] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 10/02/2023] [Indexed: 11/09/2023]
Abstract
BACKGROUND AND AIM Germline mutations of telomere-related genes (TRG) induce multiorgan dysfunction, and liver-specific manifestations have not been clearly outlined. We aimed to describe TRG mutations-associated liver diseases. APPROACH AND RESULTS Retrospective multicenter analysis of liver disease (transaminases > 30 IU/L and/or abnormal liver imaging) in patients with TRG mutations. Main measurements were characteristics, outcomes, and risk factors of liver disease in a TRG mutations cohort. The prevalence of liver disease was compared to a community-based control group (n = 1190) stratified for age and matched 1:3 for known risk factors of liver disease. Among 132 patients with TRG mutations, 95 (72%) had liver disease, with associated lung, blood, skin, rheumatological, and ophthalmological TRG diseases in 82%, 77%, 55%, 39%, and 30% of cases, respectively. Liver biopsy was performed in 52/95 patients, identifying porto-sinusoidal vascular disease in 48% and advanced fibrosis/cirrhosis in 15%. After a follow-up of 21 months (12-54), ascites, hepato-pulmonary syndrome, variceal bleeding, and HCC occurred in 14%, 13%, 13%, and 2% of cases, respectively. Five-year liver transplantation-free survival was 69%. A FIB-4 score ≥ 3·25 and ≥1 risk factor for cirrhosis were associated with poor liver transplantation-free survival. Liver disease was more frequent in patients with TRG mutations than in the paired control group [80/396, (20%)], OR 12.9 (CI 95%: 7.8-21.3, p < 0.001). CONCLUSIONS TRG mutations significantly increase the risk of developing liver disease. Although symptoms may be mild, they may be associated with severe disease. Porto-sinusoidal vascular disease and cirrhosis were the most frequent lesions, suggesting that the mechanism of action is multifactorial.
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Affiliation(s)
- Sabrina Sidali
- Université de Paris, AP-HP, C, DMU DIGEST, Centre de Référence des Maladies Vasculaires du Foie, FILFOIE, ERN RARE-LIVER, Centre de Recherche sur l'inflammation, Inserm, Paris, France
- Centre Hospitalier Universitaire Charles Nicolle, Hépato-Gastroentérologie, Rouen, France
| | - Raphaël Borie
- APHP, Service de Pneumologie, Centre de Référence des Maladies Pulmonaires Rares, FHU APOLLO, Hôpital Bichat, Paris, France
| | - Flore Sicre de Fontbrune
- Hematology Transplant Unit, Hôpital Saint louis, APHP, Paris, France, and French National Referral Center for Aplastic Anemia, CRMR
| | - Kinan El Husseini
- APHP, Service de Pneumologie, Centre de Référence des Maladies Pulmonaires Rares, FHU APOLLO, Hôpital Bichat, Paris, France
- Centre Hospitalier Universitaire Charles Nicolle, Pneumologie, Rouen, France
| | - Pierre-Emmanuel Rautou
- Université de Paris, AP-HP, C, DMU DIGEST, Centre de Référence des Maladies Vasculaires du Foie, FILFOIE, ERN RARE-LIVER, Centre de Recherche sur l'inflammation, Inserm, Paris, France
| | | | - Odile Goria
- Université de Paris, AP-HP, C, DMU DIGEST, Centre de Référence des Maladies Vasculaires du Foie, FILFOIE, ERN RARE-LIVER, Centre de Recherche sur l'inflammation, Inserm, Paris, France
- Centre Hospitalier Universitaire Charles Nicolle, Hépato-Gastroentérologie, Rouen, France
| | - Bruno Crestani
- APHP, Service de Pneumologie, Centre de Référence des Maladies Pulmonaires Rares, FHU APOLLO, Hôpital Bichat, Paris, France
| | | | - Vincent Cottin
- Centre Hospitalier Universitaire Lyon Sud, Pneumologie, Pierre-Bénite, France
| | - Vincent Bunel
- APHP, Service de Pneumologie, Centre de Référence des Maladies Pulmonaires Rares, FHU APOLLO, Hôpital Bichat, Paris, France
| | | | - Emmanuel Jacquemin
- Hôpital Kremlin-Bicêtre AP-HP, Hépatologie Pédiatrique, Le Kremlin-Bicêtre, France
| | - Noémi Reboux
- Centre Hospitalier Régional Universitaire Morvan, Hépatologie, Brest, France
| | - Sandrine Hirschi
- Centre Hospitalier Universitaire de Strasbourg, Pneumologie, Strasbourg, France
| | - Arnaud Bourdin
- Centre Hospitalier Universitaire de Montpellier, Pneumologie, Montpellier, France
| | - Magdalena Meszaros
- Centre Hospitalier Universitaire de Montpellier, Hépatologie, Montpellier, France
| | - Sebastien Dharancy
- Centre Hospitalier Régional Universitaire de Lille, Hépatologie, Lille, France
| | | | | | | | - Louis Terriou
- Centre Hospitalier Régional Universitaire de Lille, Médecine interne- Hématologie, Lille, France
| | - Frédéric Gottrand
- Univ. Lille, CHU Lille, Department of pediatric gastroenterology hepatology and nutrition, Inserm, Lille, France
| | - Wadih Abou Chahla
- Centre Hospitalier Régional Universitaire de Lille, Hémato-Pédiatrie, Lille, France
| | | | - Paul Carrier
- Hôpital Universitaire Dupuytren, Hépatologie, Limoges, France
| | - Faouzi Saliba
- Hôpital Paul-Brousse, AP-HP, Hépatologie, Villejuif, France
| | | | - John-David Aubert
- Centre Hospitalier Universitaire Vaudois, Pneumologie, Lausanne, Suisse
| | - Laure Elkrief
- Centre Hospitalier Régional Universitaire de Tours, Hépatologie, Tours, France
| | - Victor de Lédinghen
- Centre Hospitalier Universitaire - Haut-Lévêque, Hépatologie, Pessac, France
| | - Armand Abergel
- Centre Hospitalier Universitaire, Hépatologie, Clermont-Ferrand, France
| | | | - Pauline Houssel
- Centre Hospitalier Universitaire, Hépatologie, Rennes, France
| | | | - Lidwine Wemeau
- Centre Hospitalier Régional Universitaire de Lille, Pneumologie, Lille, France
| | - Anne Bergeron
- Hôpitaux Universitaires de Genève (HUG), Pneumologie, Genève, Suisse
| | - Thierry Leblanc
- Hematology Transplant Unit, Hôpital Saint louis, APHP, Paris, France, and French National Referral Center for Aplastic Anemia, CRMR
| | | | - Eric Nguyen Khac
- Centre Hospitalier Universitaire Amiens-Picardie Site Sud, Hépatologie, Amiens, France
| | | | - Ibrahima Ba
- Hôpital Bichat-Claude Bernard AP-HP, Génétique, Paris, France
| | | | | | | | | | - Hilario Nunes
- Hôpital Avicenne AP-HP, Pneumologie, Bobigny, France
| | | | - François Durand
- Université de Paris, AP-HP, C, DMU DIGEST, Centre de Référence des Maladies Vasculaires du Foie, FILFOIE, ERN RARE-LIVER, Centre de Recherche sur l'inflammation, Inserm, Paris, France
| | - Claire Francoz
- Université de Paris, AP-HP, C, DMU DIGEST, Centre de Référence des Maladies Vasculaires du Foie, FILFOIE, ERN RARE-LIVER, Centre de Recherche sur l'inflammation, Inserm, Paris, France
| | | | - Dominique Valla
- Université de Paris, AP-HP, C, DMU DIGEST, Centre de Référence des Maladies Vasculaires du Foie, FILFOIE, ERN RARE-LIVER, Centre de Recherche sur l'inflammation, Inserm, Paris, France
| | | | | | - Aurélie Plessier
- Université de Paris, AP-HP, C, DMU DIGEST, Centre de Référence des Maladies Vasculaires du Foie, FILFOIE, ERN RARE-LIVER, Centre de Recherche sur l'inflammation, Inserm, Paris, France
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