Long-term liver dysfunction after allogeneic bone marrow transplantation : clinical features and course in 61 patients

• Published in: Bone marrow transplantation (Basingstoke) Vol. 26; no. 6; pp. 649 - 655
• Main Authors: TOMAS, J. F, PINILLA, I, GARCIA-BUEY, M. L, GARCIA, A, FIGUERA, A, GOMEZ-GARCIA DE SORIA, V, MORENO, R, FERNANDEZ-RANADA, J. M
• Format: Journal Article
• Language: English
• Published: Basingstoke Nature Publishing Group 01-09-2000
• Subjects: Adolescent; Adult; Alanine Transaminase - blood; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Bone marrow; Bone Marrow Transplantation; Bone marrow, stem cells transplantation. Graft versus host reaction; Child; Child, Preschool; Chronic Disease; Evolution; Female; Follow-Up Studies; Gastroenterology. Liver. Pancreas. Abdomen; Graft versus host disease; Graft vs Host Disease - etiology; Graft-versus-host reaction; Hepatitis; Hepatitis B; Hepatitis B - etiology; Hepatitis C; Hepatitis C, Chronic - etiology; Hepatitis, Autoimmune - etiology; Humans; Infections; Interferon; Iron; Iron Overload - etiology; Liver; Liver diseases; Liver Diseases - enzymology; Liver Diseases - epidemiology; Liver Diseases - etiology; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Male; Medical sciences; Middle Aged; Morbidity; Other diseases. Semiology; Overloading; Patients; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Prevalence; Retrospective Studies; Siderosis; Signs and symptoms; Stem cell transplantation; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Transplantation; Transplantation, Homologous; Human; Immunopathology; Prognosis; Stem cell; Hematopoietic cell; Homograft; Hepatic disease; Metabolic diseases; Graft versus host reaction; Iron; Hemosiderosis; Infection; Liver function; Chronic; Viral hepatitis; Viral disease; Bone marrow; Digestive diseases; Graft; Complication
• ISSN: 0268-3369; 1476-5365
• DOI: 10.1038/sj.bmt.1702532

This retrospective study has aimed at determining the prevalence, aetiology and clinical evolution of chronic liver disease (CLD) after allogeneic bone marrow transplantation (BMT). A total of 106 patients who had been transplanted in a single institution and who had survived for at least 2 years after BMT were studied. The prevalence of CLD was 57.5% (61/106). In 47.3% of cases more than one aetiopathogenic agent coexisted. The causes of CLD were iron overload (52.4%), chronic hepatitis C (47.5%), chronic graft-versus-host disease (C-GVHD) (37.7%), hepatitis B (6.5%), non-alcoholic steatohepatitis (NASH) (4.9%), autoimmune hepatitis (AIH) (4.9%) and unknown two (3.3%). Twenty-three patients with iron overload underwent venesections which were well tolerated. An improvement in liver function tests (LFTs) was observed in 21 (91%) patients. All six patients with siderosis as the only cause of CLD normalized LFT as well as three patients with HCV infection. Clinical evolution was satisfactory for patients with GVHD, AIH, NASH and hepatitis B. At the last visit 23 patients continued with abnormal LFTs, and 19 of them were infected by the HCV. A sustained biochemical and virologic response was achieved in only one case out of six patients with CHC who received interferon. We have found that CLD is a common complication in long-term BMT survivors. The aetiology is often multifactorial, iron overload, CHC and C-GVHD being the main causes. The CLD followed a rather 'benign' and slow course in our patients as none of them developed symptoms or signs of liver failure and we did not observe an increase in morbidity or mortality in these patients, but a longer follow-up is necessary in HCV infected patients based on the natural history of this infection in other populations.