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Cirrhosis of the liver in long-term marrow transplant survivors
S I Strasser1, K M Sullivan, D Myerson
1Gastroenterology/Hepatology, Long-Term Follow-Up and Clinical Statistics Sections of the Fred Hutchinson Cancer Research Center, University of Washington School of Medicine, Seattle, WA, USA.
Insights
Cirrhosis is a significant long-term risk for hematopoietic cell transplantation (HCT) survivors, primarily caused by hepatitis C virus infection. Regular liver function monitoring is crucial for early detection in these patients.
Area of Science:
- Hepatology
- Transplantation Medicine
- Oncology
Background:
- Hematopoietic cell transplantation (HCT) survivors face risks for chronic liver disease.
- Hepatitis virus infection, iron overload, and chronic graft-versus-host disease (GVHD) are known risk factors.
Purpose of the Study:
- To evaluate risk factors for cirrhosis development in long-term HCT survivors.
- To determine the incidence and causes of cirrhosis post-HCT.
Main Methods:
- Retrospective study of 3,721 patients surviving ≥1 year post-HCT.
- Histologic or clinical evidence of cirrhosis was identified.
- Matched control subjects were used for comparison.
Main Results:
- Cirrhosis was diagnosed in 31 patients, with a cumulative incidence of 3.8% after 20 years.
- Hepatitis C virus infection was present in 81% of cirrhosis cases (P=.01).
- Cirrhosis was attributed to hepatitis C in 15 of 16 patients diagnosed >10 years post-HCT.
Conclusions:
- Cirrhosis is an important late complication of HCT.
- Chronic hepatitis C is the primary cause of cirrhosis in HCT survivors.
- Long-term survivors require evaluation for abnormal liver function and hepatitis virus infection.
Abstract:
Patients who survive hematopoietic cell transplantation (HCT) have multiple risk factors for chronic liver disease, including hepatitis virus infection, iron overload, and chronic graft-versus-host disease (GVHD). We studied 3,721 patients who had survived 1 or more years after HCT at a single center and identified patients with histologic or clinical evidence of cirrhosis. Risk factors for the development of cirrhosis were evaluated and compared with a group of matched control subjects. Cirrhosis was identified in 31 of 3,721 patients surviving 1 or more years after HCT, 23 of 1,850 patients surviving 5 or more years, and in 19 of 860 patients surviving 10 or more years. Cumulative incidence after 10 years was estimated to be 0.6% and after 20 years was 3.8%. The median time from HCT to the diagnosis of cirrhosis was 10.1 years (range, 1.2 to 24.9 years). Twenty-three patients presented with complications of portal hypertension, and 1 presented with hepatocellular carcinoma. Thirteen patients have died from complications of liver disease, and 2 died of other causes. Three patients have undergone orthotopic liver transplantation. Hepatitis C virus infection was present in 25 of 31 (81%) of patients with cirrhosis and in 14 of 31 (45%) of controls (P =.01). Cirrhosis was attibutable to hepatitis C infection in 15 of 16 patients presenting more than 10 years after HCT. There was no difference in the prevalence of acute or chronic GVHD, duration of posttransplant immunosuppression, or posttransplant marrow iron stores between cases and controls. Cirrhosis is an important late complication of hematopoietic cell transplantation and in most cases is due to chronic hepatitis C. Long-term survivors should be evaluated for the presence of abnormal liver function and hepatitis virus infection.