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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
Summary
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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