LIVER-DISEASE COMPLICATING BONE-MARROW TRANSPLANTATION - CLINICAL AUDIT

Hepatic dysfunction following bone marrow transplantation (BMT) may pr esent complex management issues. The incidence and aetiology of abnorm al liver function following allogeneic and autologous BMT was reviewed over a 2 year period in Royal Perth Hospital and these findings were related to management decisions and patient outcome. Abnormal serum li ver biochemistry during the first 12 post-transplant months occurred i n all allogeneic (n = 31) and 14 of 23 (61%) autologous transplant pat ients; 13 (41%) allogeneic and three (13%) autologous patients develop ed severe hepatic dysfunction. In allogeneic transplants, the most com mon causes of liver disease were graft-versus-host disease (33%), drug hepatotoxicity (19%) and posttransplant viral hepatitis (15%); in aut ologous patients, disease recurrence (28%) and sepsis (17%) were the m ost frequent identifiable cause of abnormal liver function. The aetiol ogy of abnormal liver biochemistry was not determined in 13 instances, but this did not adversely affect patient outcome. Percutaneous liver biopsy or endoscopic cholangiography were only required in three pati ents. Liver disease contributed to death in two allogeneic patients wi th multiple causes for liver dysfunction, and in one patient with refr actory severe hepatic graft-versus-host disease. It was concluded that hepatic dysfunction is common after BMT, the cause of which can be de termined in many cases with simple non-invasive tests used in conjunct ion with the clinical setting. Specific treatment, where necessary, is then able to be commenced in a majority of patients without the need for invasive investigation.