Advances in prevention and treatment of hepatic disorders following hematopoietic cell transplantation

Best Practice & Research. Clinical Haematology
G B McDonald

Abstract

Development of jaundice is an ominous prognostic sign, whether it occurs early or late in the months following hematopoietic cell transplant. In the first weeks after transplant, the dominant causes of liver injury are Sinusoidal Obstruction Syndrome (toxic damage resulting from myeloablative conditioning regimens) and cholangitis lenta (cholestasis of sepsis). Later after transplant, cholestasis is more commonly caused by acute graft-vs.-host disease and drugs. Hepatic infections have become uncommon because of the use of prophylactic anti-fungal and anti-viral drugs. Treatment of severe liver dysfunction is often futile in this setting, but prevention of liver injury is feasible. Hepatic sinusoidal injury can be prevented by avoiding sinusoidal toxins as part of conditioning therapy in patients at high-risk. Cholestatic liver damage can be minimized by prophylactic use of ursodiol and by careful drug monitoring. Anti-microbial drugs will prevent most fungal liver infections and viral hepatitis caused by herpesviruses and hepatitis B virus.

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Citations

Oct 16, 2014·Transplantation Reviews·J P Norvell
Jun 21, 2007·Transplantation Proceedings·G T SucakR Haznedar
Dec 17, 2008·Bone Marrow Transplantation·F R KerbauyJ S R Oliveira
Oct 3, 2015·International Psychogeriatrics·Sylwia GórskaPeter Haughey
Dec 5, 2019·European Journal of Hospital Pharmacy. Science and Practice·Laura Baladé MartínezAlícia Herrero Ambrosio
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Aug 18, 2017·Academic Pathology·Karen L KaulRichard B Thomson
Jul 22, 2018·Biology of Blood and Marrow Transplantation : Journal of the American Society for Blood and Marrow Transplantation·Natalia MaximovaLorenzo D'Antiga

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