Adverse Impact of Pre‐Transplant Liver Dysfunction in Allogeneic Hematopoietic Cell Transplantation

Although the hematopoietic cell transplantation (HCT)-comorbidity index (HCT-CI) score is associated with an increased risk of mortality after allogeneic HCT, it remains unclear how pre-HCT liver dysfunction affects clinical outcomes. We retrospectively compared clinical HCT outcomes among four groups stratified according to the presence of HCT-CI liver and other organ scores, using a Japan transplant registry database between 2010 and 2020. Of the 14235 recipients, 1527 tested positive for an HCT-CI liver score including HBV or HCV hepatitis (n = 503). The 5-year overall survival (OS) was significantly lower in the HCT-CI liver(+) other(+) and HCT-CI liver(-) other(+) groups compared to the HCT-CI liver(+) other(-) and HCT-CI liver(-) other(-) groups [49.9% vs. 59% vs. 66.5% vs. 68.3%, p < 0.001]. A multivariate analysis showed that both the HCT-CI liver(+) other(+) [HR 1.62, p < 0.001] and HCT-CI liver(-) other(+) groups [HR 1.21, p < 0.001] were significantly associated with inferior OS. Similarly, both the HCT-CI liver(+) other(+) [HR 1.89, p < 0.001] and liver(-) other(+) groups [HR 1.26, p < 0.001] were significantly associated with an increased risk of NRM. On the other hand, the HCT-CI liver(+) other(-) group was not associated with either OS or NRM. Separately analyzing the subcohorts with or without HCT-CI other scores, the presence of an HCT-CI liver score alone did not affect survival, while the co-presence of pretransplant liver dysfunction seemed to synergistically increase the adverse impact on OS and NRM among recipients with other organ comorbidities. Further studies will be needed to identify optimal strategies for recipients with pretransplant liver dysfunction.

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Journal
American Journal of Hematology
Published
2025-03-08
DOI
https://doi.org/10.1002/ajh.27652
Primary Topic
Hematopoietic Stem Cell Transplantation
Type
article
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article

Adverse Impact of Pre‐Transplant Liver Dysfunction in Allogeneic Hematopoietic Cell Transplantation

Masatsugu Tanaka, Masaharu Tamaki, Naoyuki Uchida, Yoshinobu Kanda et al.
American Journal of Hematology
Hematopoietic Stem Cell Transplantation
article

Adverse Impact of Pre‐Transplant Liver Dysfunction in Allogeneic Hematopoietic Cell Transplantation

Masatsugu Tanaka, Masaharu Tamaki, Naoyuki Uchida, Yoshinobu Kanda, Yuta Katayama, Mamiko Sakata‐Yanagimoto, Yuta Hasegawa, Noboru Asada, Ryu Yanagisawa, Noriko Doki, Kimikazu Yakushijin, Tetsuya Nishida, Hideki Nakasone, Shuichi Ota, Junya Kanda, Makoto Onizuka, Yukiko Misaki, Takahiro Fukuda, Masashi Sawa, Yoshiko Atsuta
article en

Abstract

Although the hematopoietic cell transplantation (HCT)-comorbidity index (HCT-CI) score is associated with an increased risk of mortality after allogeneic HCT, it remains unclear how pre-HCT liver dysfunction affects clinical outcomes. We retrospectively compared clinical HCT outcomes among four groups stratified according to the presence of HCT-CI liver and other organ scores, using a Japan transplant registry database between 2010 and 2020. Of the 14235 recipients, 1527 tested positive for an HCT-CI liver score including HBV or HCV hepatitis (n = 503). The 5-year overall survival (OS) was significantly lower in the HCT-CI liver(+) other(+) and HCT-CI liver(-) other(+) groups compared to the HCT-CI liver(+) other(-) and HCT-CI liver(-) other(-) groups [49.9% vs. 59% vs. 66.5% vs. 68.3%, p < 0.001]. A multivariate analysis showed that both the HCT-CI liver(+) other(+) [HR 1.62, p < 0.001] and HCT-CI liver(-) other(+) groups [HR 1.21, p < 0.001] were significantly associated with inferior OS. Similarly, both the HCT-CI liver(+) other(+) [HR 1.89, p < 0.001] and liver(-) other(+) groups [HR 1.26, p < 0.001] were significantly associated with an increased risk of NRM. On the other hand, the HCT-CI liver(+) other(-) group was not associated with either OS or NRM. Separately analyzing the subcohorts with or without HCT-CI other scores, the presence of an HCT-CI liver score alone did not affect survival, while the co-presence of pretransplant liver dysfunction seemed to synergistically increase the adverse impact on OS and NRM among recipients with other organ comorbidities. Further studies will be needed to identify optimal strategies for recipients with pretransplant liver dysfunction.

American Journal of HematologyVol. 100(5)
Tokai University (JP), Jichi Medical University (JP), Aichi Medical University (JP), Kyoto University (JP), Kanagawa Prefectural Hospital Organization (JP), Tokyo Metropolitan Komagome Hospital (JP), Kobe University Hospital (JP), Okayama University Hospital (JP), Hiroshima Red Cross Hospital & Atomic-bomb Survivors Hospital (JP), Sapporo Hokuyu Hospital (JP), University of Tsukuba Hospital (JP), Shinshu University Hospital (JP), Japanese Red Cross Nagoya Daiichi Hospital (JP), Hokkaido University Hospital (JP), Anjo Kosei Hospital (JP), The Japanese Data Center for Hematopoietic Cell Transplantation (JP), Jichi Medical University Saitama Medical Center (JP), Toranomon Hospital (JP), Kanagawa Cancer Center
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Hematopoietic Stem Cell Transplantation
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