medigraphic.com
Órgano Oficial de la Asociación Mexicana de Hepatología

2013, Number 1

<< Back Next >>

Ann Hepatol 2013; 12 (1)

Liver fibrosis in young Egyptian beta-thalassemia major patients: relation to hepatitis C virus and compliance with chelation

Elalfy MS, Esmat G, Matter RM, Abdel AHE, Massoud WA

Language: English
References: 42
Page: 54-61
PDF size: 153.96 Kb.


ABSTRACT

Background. The main causes of liver fibrosis in transfusion-dependent thalassemia major are hepatitis C virus (HCV) infection and hepatic iron overload. The study aimed to assess liver fibrosis in Egyptian adolescents and young adult poly-transfused beta thalassemia patients infected with HCV using liver FibroScan in relation to iron overload and Liver iron concentration (LIC). Material and methods. Fifty-one regularly transfused beta thalassemia patients above 12 years old were subjected to measurement of serum alanine transaminase (ALT), serum ferritin (SF), HCV (antibody and RNA), LIC assessed by hepatic R2* and transient elastography (TE) (FibroScan). FibroTest and liver biopsy were done to 25 patients. Results. Eighty two% of studied thalassemia patients were HCV antibody positive; 21(49%) of them were viremic (HCV RNA positive); median LIC was 12 mg/gm dry weight. There were strong positive correlation between the degree of liver stiffness and Ishak fibrosis score assessed in liver biopsy specimens (P = 0.002) and between FibroScan and FibroTest results (P ‹ 0.001). Patients with HCV viremia showed significantly higher ALT, γ-glutamyl transpeptidase (GGT), SF, LIC and increased liver stiffness compared to patients with no viremia (P = 0.0001, 0.001, 0.012, 0.006 and 0.001) respectively. Liver cirrhosis (TE values › 12.5kPa) was encountered in 23.5% and variable degrees of liver fibrosis (TE values › 6-12.5 kPa) in 35% of studied thalassemic patients. Conclusion. Young beta thalassemia patients with active hepatitis C infection may have hepatic cirrhosis or fibrosis at young age when accompanied with hepatic siderosis. Non invasive Liver FibroScan and Fibro- Test were reliable methods to assess liver fibrosis in young thalassemic-patients.


REFERENCES

  1. Cohen AR, Galanello R, Pennell DJ, Cunningham MJ, Vichinsky E. Thalassemia. Hematology Am Soc Hematol Educ Program 2004: 14-34.

  2. Fernandez-Rodriguez CM, Gutierrez ML, Serrano PL, Lledó JL, Santander C, Fernández TP, Tomás E, et al. Factors influencing the rate of fibrosis progression in chronic hepatitis C. Dig Dis Sci 2004; 49: 1971-6.

  3. Lin TJ, Liao LY, Lin SY, Lin CL, Chang TA. Influence of iron on the severity of hepatic fibrosis in patients with chronic hepatitis C. World J Gastroenterol 2006; 12: 4897-901.

  4. Guyader D, Thirouard AS, Erdtmann L, Rakba N, Jacquelinet S, Danielou H, Perrin M, et al. Liver iron is a surrogate marker of severe fibrosis in chronic hepatitis C. J Hepatol 2007; 46: 587-95.

  5. Fontaine H, Petitprez K, Roudot-Thoraval F, Trinchet JC. Guidelines for the diagnosis of uncomplicated cirrhosis. Gastroenterol Clin Biol 2007; 31: 504-9.

  6. Ziol M, Handra-Luca A, Kettaneh A, Christidis C, Mal F, Kazemi F, de Lédinghen V, et al. Noninvasive assessment of liver fibrosis by measurement of stiffness in patients with chronic hepatitis C. Hepatology 2005; 41: 48-54.

  7. Sporea I, Sirli R, Deleanu A, Tudora A, Curescu M, Cornianu M, Lazar D. Comparison of the liver stiffness measurement by transient elastography with the liver biopsy. World J Gastroenterol 2008; 14: 6513-7.

  8. Lupsor M, Badea R, Stefãnescu H, Grigorescu M, Sparchez Z, Serban A, Branda H, et al. Analysis of histopathological changes that influence liver stiffness in chronic hepatitis C. Results from a cohort of 324 patients. J Gastrointestin Liver Dis 2008; 17: 155-63.

  9. Blanc PL, Gabbuti A, Marino N, Mecocci L, Mazzotta F. Liver stiffness in chronic hepatitis C: will it modify the assessment of patients? J Hepatol 2007; 46(Suppl. 1): S201-S202.

  10. Fraquelli M, Cassinerio E, Roghi A, Rigamonti C, Casazza G, Colombo M, Massironi S, et al. Transient elastography in the assessment of liver fibrosis in adult thalassemia patients. Am J Hematol 2010; 85: 564-8.

  11. Cohen AR, Glimm E, Porter JB. Effect of transfusional iron intake on response to chelation therapy in beta-thalassemia major. Blood 2008; 111: 583-7.

  12. Poynard T, Imbert-Bismut F, Munteanu M, Messous D, Myers RP, Thabut D, Ratziu V, et al. Overview of the diagnostic value of biochemical markers of liver fibrosis (FibroTest, HCV FibroSure) and necrosis (ActiTest) in patients with chronic hepatitis C. Comp Hepatol 2004; 23: 8.

  13. Shaheen AA, Wan AF, Myers RP. FibroTest and FibroScan for the Prediction of Hepatitis C-Related Fibrosis: A Systematic Review of Diagnostic Test Accuracy. Am J Gastroenterol 2007; 102: 2589-600.

  14. St. Pierre TG, Clark PR, Chua-anusorn W, Fleming AJ, Jeffrey GP, Olynyk JK, Pootrakul P, et al. Noninvasive measurement and imaging of liver iron concentrations using proton magnetic resonance. Blood 2005; 105: 855-61.

  15. Ishak K, Baptista A, Bianchi L, Callea F, De Groote J, Gudat F, Denk H, et al Histological grading and staging of chronic hepatitis. J Hepatol 1995; 22: 696-9.

  16. Sandrin L, Fourquet B, Hasquenoph JM, Yon S, Fournier C, Mal F, Christidis C, et al. Transient elastography: a new noninvasive method for assessment of hepatic fibrosis. Ultrasound Med Biol 2003; 29: 1705-13.

  17. Castera L, Vergniol J, Foucher J, Le Bail B, Chanteloup E, Haaser M, Darriet M, et al. Prospective comparison of transient elastography, Fibrotest, APRI, and liver biopsy for the assessment of fibrosis in chronic hepatitis C. Gastroenterology 2005; 128: 343-50.

  18. Wang JH, Changchien CS, Hung CH, Eng HL, Tung WC, Kee KM, Chen CH, et al. FibroScan and ultrasonography in the prediction of hepatic fibrosis in patients with chronic viral hepatitis. J Gastroenterol 2009; 44: 439-46.

  19. el-Gohary A, Hassan A, Nooman Z, Lavanchy D, Mayerat C, el-Ayat A, Fawaz N, et al. High prevalence of hepatitis C virus among urban and rural population groups in Egypt. Acta Trop 1995; 59: 155-61.

  20. el-Nanawy AA, el-Azzouni OF, Soliman AT, Amer AE, Demian RS, el-Sayed HM. Prevalence of hepatitis-C antibody seropositivity in healthy Egyptian children and four high risk groups. J Trop Pediatr 1995; 41: 341-3.

  21. Ragab L, Helal S, Zaghloul N, El-Raziky M, Afifi R, Musallam KM, Taher A. Clinic-virologic analysis of hepatitis C infection in transfusion-dependent beta-thalassemia major children. Int J Lab Hematol 2010; 32: 184-90.

  22. Prati D, Maggioni M, Milani S, Cerino M, Cianciulli P, Coggi G, Forni GL, et al.; Cooley care Cooperative Group. Clinical and histological characterization of liver disease in patients with transfusion-dependent beta-thalassemia. A multicenter study of 117 cases. Haematologica 2004; 89: 1179-86.

  23. Li CK, Chik KW, Lam CW, To KF, Yu SC, Lee V, Shing MM, et al. Liver disease in transfusion dependent thalassaemia major. Arch Dis Child 2002; 86: 344-7.

  24. Cunningham MJ, Macklin EA, Neufeld EJ, Cohen AR. Thalassemia Clinical Research Network. Complications of β-thalassemia major in North America. Blood 2004; 104: 34-9.

  25. Ardalan FA, Osquei MR, Toosi MN, Irvanloo G. Synergic effect of chronic hepatitis C infection and beta thalassemia major with marked hepatic iron overload on liver fibrosis: a retrospective cross-sectional study. BMC Gastroenterol 2004; 4: 17.

  26. Perifanis V, Tziomalos K, Tsatra I, Karyda S, Patsiaoura K, Athanassiou-Metaxa M. Prevalence and severity of liver disease in patients with β thalassemia major. A single-institution fifteen-year experience. Haematologica 2005; 90: 1136-8.

  27. Hoare M, Gelson WT, Rushbrook SM, Curran MD, Woodall T, Coleman N, Davies SE, et al. Histological changes in HCV antibody-positive, HCV RNA-negative subjects suggest persistent virus infection. Hepatology 2008; 48: 1737-45.

  28. Papastamataki M, Delaporta P, Premetis E, Kattamis A, Ladis V, Papassotiriou I. Evaluation of liver fibrosis in patients with thalassemia: the important role of hyaluronic acid. Blood Cells Mol Dis 2010; 45: 215-8.

  29. Piperno A, D’Alba R, Fargion S, Roffi L, Sampietro M, Parma S, Arosio V, et al. Liver iron concentration in chronic viral hepatitis: a study of 98 patients. Eur J Gastroenterol Hepatol 1995; 7: 1203-8.

  30. Rigamonti C, Andorno S, Maduli E, Morelli S, Pittau S, Nicosia G, Boldorini R, et al. Iron, hepatic stellate cells and fibrosis in chronic hepatitis C. Eur J Clin Invest 2002; 32(Suppl 1): 28-35.

  31. Beinker NK, Vogt MD, Arendse M, Smit J, Stander IA, Kirsch RE. Threshold effect of liver iron content on hepatic inflammation and fibrosis in hepatitis B and C. J Hepatol 1996; 25: 633-8.

  32. Anwar M, Nadeem A, Jamal S, Dilawar M, Ali W, Aziz S, Ayyub M, et al. Effect of HCV infection on hepatic fibrosis in patients of thalassaemia major. J Coll Physicians Surg Pak 2006; 16: 200-3.

  33. Mirault T, Lucidarme D, Turlin B, Vandevenne P, Gosset P, Ernst O, Rose C. Non-invasive assessment of liver fibrosis by transient elastography in post transfusional iron overload. Eur J Haematol 2008; 80: 337-40.

  34. Di Marco V, Bronte F, Cabibi D, Calvaruso V, Alaimo G, Borsellino Z, Gagliardotto F, et al. Noninvasive assessment of liver fibrosis in thalassaemia major patients by transient elastography (TE)-lack of interference by iron deposition. Br J Haematol 2010; 148(3): 476-9.

  35. de Lédinghen V, Le Bail B, Rebouissoux L, Fournier C, Foucher J, Miette V, Castéra L, et al. Liver stiffness measurement in children using FibroScan: feasibility study and comparison with Fibrotest, aspartate transaminase to platelets ratio index, and liver biopsy. J Pediatr Gastroenterol Nutr 2007; 45: 443-50.

  36. Dolmazashvili E, Zhamutashvili M, Svanidze M, Nizharadze N, Abutidze A. Fibroscan and FibroTest/FibroMax to assess liver fibrosis/cirrhosis in patients with chronic HBV and HCV infection in Georgia. Georgian Med News 2008; (165): 83-7.

  37. Smith JO, Sterling RK. Systematic review: non-invasive methods of fibrosis analysis in chronic hepatitis C. Aliment Pharmacol Ther 2009; 30(6): 557-76.

  38. Angelucci E, Muretto P, Nicolucci A, Baronciani D, Erer B, Gaziev J, Ripalti M, et al. Effects of iron overload and hepatitis C virus positivity in determining progression of liver fibrosis in thalassemia following bone marrow transplantation. Blood 2002; 100(1): 17-21.

  39. Wanless IR, Sweeney G, Dhillon AP, Guido M, Piga A, Galanello R, Gamberini MR, et al. Lack of progressive hepatic fibrosis during long-term therapy with deferiprone in subjects with transfusion-dependent beta-thalassemia. Blood 2002; 100: 1566-9.

  40. Wu SF, Peng CT, Wu KH, Tsai CH. Liver fibrosis and iron levels during long-term deferiprone treatment of thalassemia major patients. Hemoglobin 2006; 30: 215-8.

  41. Chen AC, Peng CT, Wu SF, Wu KH, Chiang IP, Tsai CH. Effect of deferiprone on liver iron overload and fibrosis in hepatitis-C-virus-infected thalassemia. Hemoglobin 2006; 30(2): 209-14.

  42. Di Marco V, Capra M, Gagliardotto F, Borsellino Z, Cabibi D, Barbaria F, Ferraro D, et al. Liver disease in chelated transfusion-dependent thalassemics: the role of iron overload and chronic hepatitis C. Haematologica 2008; 93(8): 1243-6.




2020     |     www.medigraphic.com