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Kinetics of bilirubin and liver enzymes is useful for predicting of liver graft-versus-host disease

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KREJČÍ Marta KAMELANDER Jan POSPÍŠIL Zdeněk MAYER Jiří

Rok publikování 2012
Druh Článek v odborném periodiku
Časopis / Zdroj Neoplasma
Fakulta / Pracoviště MU

Lékařská fakulta

Citace
Doi http://dx.doi.org/10.4149/neo_2012_034
Obor Onkologie a hematologie
Klíčová slova liver GVHD; kinetics; bilirubin; liver enzymes
Přiložené soubory
Popis Graft-versus-host disease (GVHD) is the most frequent complication after allogeneic hematopoietic cell transplantation. We analyzed the kinetics of bilirubin and liver enzymes in 47 cases with liver GVHD and in 47 cases without GVHD after allogeneic transplantation for various hematological malignancies. The duration of an liver GVHD episode (LGVHD) was defined as the interval from the point when the criteria of LGVHD were met to the decrease to < 2 upper normal limit (UNL) for aminotransferases or bilirubin < 34 mu mol/l for bilirubin. The imminent LGVHD episode was defined as the interval from the start of continuous increase (>= 3 consecutive rising values) of bilirubin and liver enzymes above UNL to the point of LGVHD diagnosis. The number of imminent LGVHD episodes, and median length in days were as follows: bilirubin (39;5), ALT(28;12), AST(9;12), GGTP(34;9), and ALP(13;14). Statisticallly significant associations between asymptomatic continuous increase of bilirubin, ALT, and GGTP and later liver GVHD manifestation were found (p=0.004, p=0.008, p=0.005, respectively). The asymptomatic continuous increase in bilirubin, ALT, and GGTP occurred at a median of 5, 12, and 9 days before liver GVHD episode, respectively. In the control group without GVHD, median levels of bilirubin and liver enzymes were within normal limits and no continuous increase was observed. Kinetics of bilirubin and liver enzymes is useful for predicting of liver GVHD. A continuous increase of bilirubin and/or ALT, GGTP before the standard liver GVHD criteria are met can be a sign of coming liver GVHD.
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