Καττάμης Αντώνιος, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Ευάγγελος Τέρπος, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Ευστάθιος Καστρίτης, Αναπληρωτής Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Background: Hepatitis C and chronic iron overload are the main causes of liver disease, presenting as advanced fibrosis, cirrhosis, and/or hepatocellular carcinoma(HCC). The ‘gold standard’ method for assessing liver damage is liver biopsy.
Purpose: Evaluation of the prognostic value of liver biopsy in long-term morbidity and mortality of patients with β-Thalassemia.
Method: Retrospective analysis in a group of Transfusion-Dependent(TDT) or Non-Transfusion-Dependent (NTDT) β-Thalassemia patients, who had undergone liver biopsy from 1992 to 2005, and were followed till 31/12/2020. Hepatic events were defined as liver cirrhosis, HCC, or death due to liver disease.
Results:87 patients had undergone liver biopsy at the age of 21.8 ± 6.1 years and were monitored for 19.4 years. We identified 14(16.1%) events;7 HCC,4 liver cirrhosis, and 3 deaths from liver-related causes. At 50 years of age, EFS was 75%, while 25% of patients developed liver disease in 24.4 years after the date of biopsy. High ferritin levels are associated with high siderosis levels(p=0.0003).High siderosis carries a greater risk for developing liver disease compared to low siderosis,(HR 3.00,p=0.05),HR adjusted for age(aHR 2.9,p=0.07).An increase of 50 μg/L in serum ferritin level is associated with an increased risk of developing liver disease(aHR 1.02,p=0.03). No statistically significant correlation was found between the development of liver disease and sex, hepatitis C and the degree of fibrosis, p=0.2,p=0.3, and p=0.2, respectively.
Conclusions: The occurrence of liver disease is increasing after the 4th decade of life. High ferritin and siderosis levels may be significant risk factors. Degree of liver fibrosis does not seem to be related to progression, which may be due to stabilization and/or reversal of fibrosis achieved with current chelation therapy.