| PART ONE The CAUSES AND PROGNOSIS OF LIVER INJURY AFTER HEMATOPOIETIC STEM CELL TRANSPLANTATIONObjective:To investigate the incidences, causes and prognosis of liver injury following hematopoietic stem cell transplanta -tion(HSCT).Methods:We reviewed the medical records of total 78 patients underwent hematopoietic stem cell transplantation contained 32 allogeneic and 46 autologous HSCT. Based on their liver function test and HBV serology results within one year from transplantation, we assessed the incidence and causes of moderate and severe liver injury at different stage following different type of hematopoietic stem cell transplantation. This study compared the influence of different degree liver injury after HSCT on clinical outcome with Kaplan-Meier survival analysis.Results:69.2%(54 of 78 patients)of HSCT recipients had liver injury during the first year of HSCT. The incidence of moderate and severe liver injury was higher in allogeneic HSCT than in autologous HSCT. (59.4% VS 17.4%,P<0.01) The causes of hepatotoxicity after allogeneic HSCT were drug hepatotoxicity (47.4%,9/19 cases),hepatic graft versus host disease (31.6%,6/19 cases) and hepatic venous occlusive disease (15.8%,3/19 cases) respectively, whereas the causes of hepatotoxicity after autologous HSCT were drug hepatotoxicity (37.5%,3/8 cases),HBV reactivation (12.5%,1/8 cases), malignancy recurrence(25%,2/8 cases) and sepsis(25%,2/8 cases). Kaplan–Meier survival estimates revealed that statistically significant difference in survival rate at day 100 among moderate and severe liver injury(42.3%), normal liver function (79.2%) and mild liver injury groups(64.3%) (P<0.01).Conclusion : Liver dysfunction following HSCT was a common complication. The most familiar causes of liver injury were drug hepatotoxicity ,hepatic graft versus host disease and hepatic veno-occlusive disease for allogeneic HSCT whereas drug hepatotoxicity for autologous HSCT. Severe liver dysfunction indicated a bad prognostic. PART TWO THE CAUSES AND RISK FACTORS FOR LIVER INJURY IN THE NON-HODGKIN'S LYMPHOMAObjective: To investigate the incidence and causes of liver injury in the non-Hodgkin's lymphoma and analysis the risk factors of liver injury following the chemotherapy. To analysis the incidence of HBV reactivation when using rituximab for the HBV carriers.Methods: We collected the medical records of total 181 patients diagnosed non-Hodgkin's lymphoma. Based on their liver function test, HBV serology and the results of B ultra-sound or computer tomograph, we performed a retrospective study on the incidence and cause of liver injury for 181 patients with non-Hodgkin's lymphoma(NHL) receiving chemotherapy. We analysised the risk factors for the liver dysfunction following chemotherapy using logistic regression. To learn about the influence of rituximab for the HBV reactivation among HBV carriers with the wilcoxon rank sum test.Results: 53(29.3%) of 181 cases had liver injury in the study. The incidence of moderate and severe liver injury was 22.1%(40/181 cases).Liver injury arised before chemotherapy in 17 cases (9.4%) while after chemotherapy in 36 cases(19.9%).There were 11 cases (65.7%) who diagnosed liver involved by the tumor which were the main reasons of liver injury happened before chemotherapy. The most frequent causes of liver injury following chemotherapy were drug hepatotoxicity (73.1%, 19/26 cases), HBV reactivation (11.5%, 3/26 cases).In the study, liver swelling (P<0.05) and HBV serology positive (P<0.01) were the risk factors for liver injury after chemotherapy. Using rituximab in the regimens might cause more incidences of HBV reactivation. (P<0.05)Conclusion: Liver injury was a common phenomenon in lymphoma and there were complex reasons for that. Drug-induced hepatotoxicity was the main reason for the liver injury following chemotherapy. Liver swelling and HBV serology positive were risk factors for liver dysfunction following chemotherapy. The chemotherapy including the rituximab could increased the incidences of HBV reactivation. |
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