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Morbidity and mortality due to liver disease in children undergoing allogeneic bone marrow transplantation: a 10-year
A Locasciulli1, M Testa, M G Valsecchi
1Clinica Pediatrica Università di Milano, Ematologia Pediatrica, Ospedale S. Gerardo, Monza, Milan Italy.
Insights
Liver disease after bone marrow transplantation (BMT) is common, but severe outcomes like liver failure are rare in children. Pre-existing hepatitis B or C infection did not predict severe liver damage post-BMT.
Area of Science:
- Pediatric Hepatology
- Hematology
- Transplantation Immunology
Background:
- Liver disease is a significant concern in pediatric patients undergoing bone marrow transplantation (BMT).
- Assessing long-term morbidity and mortality related to liver complications is crucial for improving patient outcomes.
Purpose of the Study:
- To evaluate the incidence and risk factors of liver disease in children following BMT.
- To determine the relationship between pre-transplant hepatitis B (HBV) and C (HCV) infection and post-transplant liver damage.
Main Methods:
- A long-term prospective study enrolled 111 children undergoing BMT between 1985 and 1995.
- Patients were followed for a median of 5.5 years post-BMT, with assessment of liver function tests and viral markers.
- Data on pre-transplant liver status, HBV/HCV infection, and post-transplant liver abnormalities were analyzed.
Main Results:
- 43% of children had abnormal alanine aminotransferase (ALT) pre-BMT; 3.6% died of liver failure post-BMT.
- 74% experienced post-BMT ALT abnormalities, mostly transient.
- No significant association found between pre-transplant HBV/HCV or elevated ALT and severe liver damage; 15% seroconverted to anti-HCV post-transplant.
Conclusions:
- While post-BMT liver abnormalities are frequent in children, severe liver disease and cirrhosis are uncommon.
- Pre-transplant hepatitis B or C infection and elevated transaminases do not predict severe post-transplant liver outcomes.
- Hepatitis C virus (HCV) was implicated in some cases of chronic liver disease, and post-transplant HBV occurred in 3.6% of patients.
Abstract:
We have conducted a long-term prospective study of children undergoing bone marrow transplantation (BMT) to assess morbidity and mortality for liver disease. One hundred eleven consecutive children were enrolled between June 1985 and June 1995 and were followed-up for a median of 5.5 years after BMT. Before transplant 48/111 children (43%) had abnormal alanine aminotransferase (ALT), none were HBsAg+ and 4/111 were anti-HCV+. After BMT 4/111 patients (3. 6%) died of liver failure. No relationship was found between pretransplant hepatitis B (HBV) or C (HCV) infection or elevated transaminases and development of severe liver damage. Eighty-two out of one hundred and eleven patients (74%) had abnormalities of ALT after BMT, transient (n = 54) or persistent (n = 28). None developed clinical signs or symptoms of end stage liver disease or of cirrhosis during follow-up. No significant difference in prevalence of liver disease, was found between children with normal or abnormal ALT at BMT (relative risk [RR] = 1.04). HCV infection could be implicated in the etiology of chronic liver disease in 14/28 patients; 2 other patients were found infected by HBV alone (1 case) or combined with HCV (1 case). In the remaining 12 the etiology of chronic liver disease could not be defined. Posttransplant hepatitis B occurred in 4/111 children (3.6%), including a recipient from a donor who had been previously vaccinated against HBV, while no patient who had been vaccinated developed hepatitis B. The rate of posttransplant seroconversion to anti-HCV was 15%.