Hepatic dysfunction in oncohematology patients

Abstract

Many situations in onco-hematology can lead to hepatic dysfunction (HD), which manifests as abnormal liver tests and affects 20% of hematology patients admitted to intensive care. Due to its non-specific clinical and biological presentation, as well as the potential multiple coexisting etiologies, the management of HD remains a challenge for clinicians. The causes of HD in solid tumor or hematological malignancies vary according to the underlying disease, treatments received, and the type of induced immunosuppression. Drug-induced hepatotoxicity, especially from immunotherapy, viral infections in immunocompromised patients, tumor-related liver involvement, and the hemophagocytic lymphohistiocytosis are the main causes of HD. Hepatotoxicity is a clinical diagnosis of exclusion. Allogeneic hematopoietic stem cell transplantation induces specific hepatobiliary complications, particularly graft-versus-host disease and sinusoidal obstruction syndrome. The aim of this review is to raise awareness among intensivists about the diverse etiologies of HD in onco-hematology to optimize the bedside diagnostic approach and improve care.