Protective Effect of Hematopoietic Stem Cell Transplantation Against the Progression of Liver Fibrosis in β-Thalassemia Major Patients

Background and Aim: Patients with β-thalassemia major (TM) arevulnerable to liver fibrosis, which is mainly due to iron overload. Aftersuccessful allogeneic hematopoietic stem cell transplantation (HSCT) forsuch patients, it is reasonable to assume that iron overload decreasesbecause of the reduction in hemolysis and cessation of therapeutictransfusions. Transient elastography (TE) is a valuable non-invasivemethod to assess liver fibrosis. In this study, using TE we sought to assessthe levels of hepatic fibrosis in TM patients before and after allo-HSCT.Methods: In this prospective observational study, 68 TM patients (57.7%male) with a median age of 7.7 (2-15) years who were a candidate toundergo allo-HSCT were included. The level of hepatic fibrosis in MTpatients was measured with TE using Fibroscan 502 (EchoSens, Paris,France) and with liver biopsy according to the METAVIR scoring system.TE, measured in kilopascals (kPa), was performed both in pre-HSCTand 1-year post-HSCT, while liver biopsy was only performed beforetransplantation.Results: Comparing laboratory findings in 1 year after HSCT with thosein pre-HSCT, a significant increase in ferritin (P= 0.001) and significantincrements in liver enzymes (P < 0.001) were observed. However, nosignificant change in liver fibrosis occurred comparing pre-HSCT andpost-HSCT TE measurements of the liver (P = 0.211). Age, gender andferritin values did not have any impact on the level of liver fibrosismeasured by TE both before and after HSCT. Moreover, pre-HSCTMETAVIR score did not show a significant impact on the change in thelevels of liver fibrosis (as assessed by TE before and after HSCT).Conclusion: Transfusion-dependent TM patients experience progressiveliver fibrosis over time. The progression of liver fibrosis arrests after HSCTas we found no significant change in TE measurements of the liver beforeand after the procedure. Hence, it can be stated that allo-HSCT is able toalleviate the hepatic fibrosis progression in TM patients.

کلیدواژه ها:

Beta-thalassemia ، Hematopoietic stem cell transplantation ، Hepatic fibrosis ، Transient elastography