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GI complications in pediatric patients post-BMT

C C Barker1, R A Anderson, R S Sauve

  • 1Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada. cbarker@cw.bc.ca

Bone Marrow Transplantation
|May 24, 2005
PubMed

Insights

Pediatric bone marrow transplant (BMT) recipients frequently experience hepatic and gastrointestinal complications. Graft-versus-host disease (GVHD) and veno-occlusive disease (VOD) significantly impact liver function, while mucositis and diarrhea are common GI issues.

Area of Science:

  • Pediatric Hematology/Oncology
  • Gastroenterology
  • Transplant Medicine

Background:

  • Bone marrow transplantation (BMT) is a critical treatment for pediatric hematologic malignancies and other diseases.
  • Post-transplant complications, particularly hepatic and gastrointestinal (GI), significantly affect patient outcomes.
  • Understanding the incidence and etiology of these complications is crucial for improving pediatric BMT care.

Purpose of the Study:

  • To comprehensively examine the spectrum and frequency of hepatic and gastrointestinal complications following pediatric BMT.
  • To identify risk factors and potential differentiating markers for specific complications like graft-versus-host disease (GVHD) and veno-occlusive disease (VOD).
  • To assess the impact of these complications on patient morbidity and mortality.

Main Methods:

  • Retrospective study analyzing data from 132 pediatric patients who underwent 142 BMTs.
  • Detailed review of medical records to identify and quantify hepatic and gastrointestinal complications.
  • Statistical analysis to determine the incidence of various complications and their associations.

Main Results:

  • High incidence of hyperbilirubinemia (28%) and clinically evident jaundice (16%).
  • Acute GVHD occurred in 46% of patients, with significant liver (39%) and intestinal (60%) involvement.
  • Veno-occlusive disease (VOD) affected 18% of patients; elevated transaminases were higher in GVHD/VOD.
  • Biliary sludging (20%), mucositis (90%), vomiting (85%), and diarrhea (67%) were common GI issues.
  • Diarrhea etiologies included GVHD (27%), viral infections (6%), C. difficile (8%), and unknown causes (28%).
  • Gastrointestinal bleeding occurred in 8% and was disproportionately linked to ICU admission and 100-day mortality.

Conclusions:

  • Hepatic and gastrointestinal complications are major contributors to morbidity and mortality in pediatric BMT recipients.
  • Serum bilirubin levels may aid in differentiating between VOD and hepatic GVHD.
  • Close monitoring and management of GI and hepatic complications are essential for improving survival rates post-pediatric BMT.

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