The role of liver biopsy in the workup of liver dysfunction late after SCT: Is the role of iron overload underestimated?

Department of Hematology, Faculty of Medicine, Gazi University, Ankara, Turkey.
Bone Marrow Transplantation (Impact Factor: 3.57). 08/2008; 42(7):461-7. DOI: 10.1038/bmt.2008.193
Source: PubMed


Abnormalities in liver function tests are common in hematopoietic SCT (HSCT) recipients. We retrospectively investigated the role of liver biopsy in determining the cause of elevated liver enzymes and its impact on the management of patients in the post-HSCT setting. A total of 24 consecutive liver biopsies were obtained from 20 patients from September 2003 to December 2007. A definite histopathologic diagnosis was obtained in 91.7% of the biopsies. Iron overload (IO) was found in 75% and GVHD in 54.2% of the patients. The initial clinical diagnosis of GVHD was confirmed in 56.5% and refuted in 43.5% of the allogeneic HSCT recipients. The median number of post transplant transfusions, percent transferrin saturation and ferritin levels were found to be higher in patients who had histologically proven hepatic IO (p1=0.007, p2=0.003 and p3=0.009, respectively). Regression analysis showed a significant correlation between serum ferritin levels and histological grade of iron in the hepatocytes. Our data suggest that hepatic IO is a frequent finding in the post-HSCT setting, which contributes to hepatic dysfunction and it should be considered in the differential diagnosis, particularly in patients with high serum ferritin levels.

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    • "All the above mentioned data is based on ferritin as a surrogate marker of IO as the liver biopsy which is the gold standard of documenting IO, is usually not feasible in the turbulent context of HSCT. The role of ferritin as the sole marker of iron status on the other hand can be questioned as it also functions as an acute phase reactant (Lee & Jacobs, 2004; Pullarkat et al., 2008; Sucak et al., 2008; Kataoka et al., 2009; Storey et al., 2009; Alessandrino et al., 2010). We aimed to investigate the role of ferritin as a surrogate marker of IO. "
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