Elastography improves accuracy of early hepato-biliary complications diagnosis after allogeneic stem cell transplantation |
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Authors: | Pierre-Edouard Debureaux Pierre Bourrier Pierre Emmanuel Rautou Anne-Marie Zagdanski Morgane De Boutiny Simona Pagliuca Aurlien Sutra de Galy Marie Robin Rgis Peffault de Latour Aurlie Plessier Flore Sicre de Fontbrune Alinor Xhaard Pedro Henrique Prata Dominique Valla Grard Socie David Michonneau |
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Institution: | 1.Hematology and Transplantation Unit, Saint Louis Hospital, APHP, Paris;2.Radiology Unit, Saint Louis Hospital, APHP, Paris;3.DHU Unit, Pôle des Maladies de l’Appareil Digestif, Service d''Hépatologie, Centre de Référence des Maladies Vasculaires du Foie, Hôpital Beaujon, AP-HP, Clichy;4.Université de Paris, INSERM U976, Paris, France |
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Abstract: | Significant morbidity and mortality have been associated with liver complications after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Causes and consequences of these hepato-biliary complications are various and might be life-threatening. A high misdiagnosis rate has been reported because of a weak correlation between clinical, laboratory and imaging data. Liver elastography, a liver stiffness measure, is able to assess liver fibrosis and portal hypertension in most liver diseases, but data after allo-HSCT are scarce. Our aim was to determine the interest of sequential liver stiffness measurements for the diagnosis of early hepatic complications after allo-HSCT. Over a 2-year time period, 161 consecutive adult patients were included and 146 were analyzed. Ultrasonography and elastography measurements were performed before transplantation, at day+7 and day+14 by three different experienced radiologists unaware of the patients’ clinical status. Eightyone (55%) patients had liver involvements within the first 100 days after allo-HSCT. Baseline elastography was not predictive for the occurrence of overall liver abnormalities. A significant increase in two-dimensional real-time shearwave elastography (2D-SWE) was found in patients with sinusoidal obstruction syndrome (SOS). Fifteen patients (10%) fulfilled European Society for Blood and Marrow Transplantation (EBMT) score criteria and twelve (8%) reached Baltimore criteria for SOS diagnosis, but only six (4%) had a confirmed SOS. 2D-SWE at day+14 allowed early detection of SOS (AUROC=0.84, P=0.004) and improved sensibility (75%), specificity (99%) and positive predictive value (60%) over the Seattle, Baltimore or EBMT scores. A 2D-SWE measurement above 8.1 kPa at day+14 after allo-HSCT seems a promising, non-invasive, and reproducible tool for early and accurate diagnosis of SOS. |
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