Disease of the liver following bone marrow transplantation in children: incidence, clinical course and outcome in a long‐term perspective

Abstract

Sixty‐four consecutive cases of allogeneic (n= 16), autologous (n= 47) or syngeneic (n= 1) bone marrow transplantation (BMT) in children with haematological or lymphoid malignancy, aplasia or metabolic disease were reviewed to assess the incidence, clinical presentation and outcome of liver disease. Median follow‐up time was 5 y (1.0‐10). No liver diagnosis was established at the pre‐transplant check‐up. During the first 100d post‐transplant, 81% of the patients had impaired liver function as documented by various biochemical parameters. Three of 64 patients (5%) met diagnostic criteria for veno‐occlusive disease. Four (25%) of the 16 receiving allografts were diagnosed as having acute graft vs host disease (GVHD) with liver involvement (grades II‐III). No patient died of liver disease. During the late post‐transplant follow‐up, one patient developed HCV hepatitis after packed erythrocyte transfusion. Four patients were diagnosed as having chronic GVHD with liver involvement; three of them also had an episode of CMV hepatitis. At their latest follow‐up, the patients with chronic GVHD had aminotransferase values 1.5–3 times the normal, whereas all other long‐term survivors had normal or near‐normal liver function tests. We conclude that the incidence of serious liver disease was low in this paediatric population of bone marrow recipients.