Document Detail


Liver disease is a major cause of mortality following allogeneic bone-marrow transplantation.
MedLine Citation:
PMID:  15618844     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Liver disease is an important cause of morbidity and mortality among recipients of bone-marrow transplantation (BMT). The aim of this retrospective study was to determine the incidence, risk factors and clinical evolution of liver disease following allogeneic BMT. METHODS: A total of 103 patients (mean age 22.8 years (SD 10.9); 31.1% aged < 18 years; 66% males) transplanted in a single institution were enrolled. Data on donors and recipients were collected, including hematological disease, alanine transaminase, alkaline phosphatase, bilirubin, hepatitis B virus (HBV) and hepatitis C virus (HCV) markers (including HBV-DNA and HCV-RNA). RESULTS: Fifty six of 103 patients died, with liver disease the main cause of death (27 of 56, 48%). Overall the incidence of liver failure attributed to hepatic graft-versus-host-disease (GVHD) was 22.3% (23 of 103; 74% HBV/HCV infected) and veno-occlusive disease (VOD) was 9.7% (10 of 103; 80% HBV/HCV infected). Fourteen patients had hepatitis reactivations (four hepatic GVHD and three VOD). Donors' HCV-RNA status and serum bilirubin above 2 mg/dl were predictive of hepatic GVHD [adjusted odds ratio (AOR) 11.1, 95% confidence interval (CI) 0.99-33.12; AOR 3.93, 95% CI 1.09-14.62; P < 0.05, respectively] and an abnormal alkaline phosphatase could predict severe liver disease (AOR 2.78, 95% CI 1.01-7.54; P < 0.05). Development of severe liver disease (hepatic GVHD or VOD) was a significant predictor of mortality (AOR 4.57, 95% CI 1.09-20.32; P < 0.05) with a low probability of survival (19.3%, SD 7.9%) compared with those without liver disease (52.1%, SD 7.6%; log-rank P = 0.0003). CONCLUSIONS: Hepatic GVHD is a common complication following BMT and an important cause of liver-related mortality. The high prevalence of HCV and HBV may have contributed to the outcome of hepatic GVHD and VOD. Therefore, antiviral therapy should be considered early to prevent relentless progression of liver disease.
Authors:
Manal H El-Sayed; Alaa El-Haddad; Omar A Fahmy; Iman I Salama; Hossam K Mahmoud
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  European journal of gastroenterology & hepatology     Volume:  16     ISSN:  0954-691X     ISO Abbreviation:  Eur J Gastroenterol Hepatol     Publication Date:  2004 Nov 
Date Detail:
Created Date:  2004-12-24     Completed Date:  2005-03-17     Revised Date:  2009-10-16    
Medline Journal Info:
Nlm Unique ID:  9000874     Medline TA:  Eur J Gastroenterol Hepatol     Country:  England    
Other Details:
Languages:  eng     Pagination:  1347-54     Citation Subset:  IM    
Affiliation:
Pediatric Department, Hematology/Oncology Division, Children's Hospital, Ain Shams University, Cairo, Egypt. manalhelsayed@yahoo.com
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Bilirubin / blood
Bone Marrow Transplantation / adverse effects*
Child
Child, Preschool
Female
Graft vs Host Disease / etiology,  mortality
Hepacivirus / isolation & purification
Hepatic Veno-Occlusive Disease / etiology,  mortality
Hepatitis / etiology,  mortality
Hepatitis B virus / isolation & purification
Humans
Liver Diseases / etiology,  mortality*
Male
Middle Aged
Prognosis
RNA, Viral / blood
Retrospective Studies
Risk Factors
Survival Analysis
Transplantation, Homologous
Chemical
Reg. No./Substance:
0/RNA, Viral; 635-65-4/Bilirubin

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