Analysis of determinant factors of liver fibrosis progression in ex-thalassemic patients
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ORIGINAL ARTICLE
Analysis of determinant factors of liver fibrosis progression in ex‑thalassemic patients Tahereh Rostami1 · Seyed Mostafa Monzavi2 · Hossein Poustchi3 · Ali Reza Khoshdel4 · Maryam Behfar2,5 · Amir Ali Hamidieh2,5 Received: 25 February 2020 / Revised: 20 August 2020 / Accepted: 7 September 2020 © Japanese Society of Hematology 2020
Abstract Allogeneic hematopoietic stem cell transplantation (allo-HSCT) potentially renders thalassemia patients disease-free with presumably cessation of associated complications. This study analyzes the liver fibrosis status and the determinants of its progression in ex-thalassemic patients. The liver fibrosis status of 108 pediatric transfusion-dependent β-thalassemia major patients was evaluated before and one year after allo-HSCT using transient elastography (TE). All patients achieved normal hematopoiesis. In univariate analyses, not in all, but in patients developing significant post-HSCT iron overload or hepatic graft-versus-host disease (GvHD), as well as recipients of bone marrow stem cells (BMSC), significant TE increment occurred. In multivariable analyses, through a model with large effect size (Adj.R2 = 26%, F(3,104) = 13.53, P 75 cm, respectively, as per the manufacturer’s instructions. To achieve optimal measurements, patient lied down in a dorsal decubitus position with maximal abduction of the right arm, and then the probe was placed on the patient’s skin, overlying the right lobe of the liver, through the intercostal
Analysis of determinant factors of liver fibrosis progression in ex‑thalassemic patients
spaces. The median value of 10 valid measurements TE, reported in kilopascals (kPa), was recorded for each subject. The recorded value was considered valid if the interquartile range was less than 30% of the median reading and/or the success rate was over 60% [15, 23]. Secondary endpoints Change in liver function, hemolysis, and iron burden were considered as secondary endpoints. To assess the liver function status, aspartate aminotransferase (AST), alanine aminotransferase (ALT) and alkaline phosphatase (ALP) were measured. The extent of hemolysis was evaluated based on the level of indirect bilirubin. Iron burden was evaluated by two measures including liver T2-weighted values of magnetic resonance imaging (T2*MRI; 1.5 T, Magnetom Symphony™, Siemens Medical Solution, Germany), and level of serum ferritin (SF). T2-weighted values of > 6.3 ms were considered normal iron concentration in the liver, while the value ranges of 2.7–6.3 ms, 1.4–2.6 ms, and
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