Successful cytokine treatment of aplastic anemia following living-related orthotopic liver transplantation for non-A, non-B, non-C hepatitis

The relationship between aplastic anemia and viral hepatitis is well recogn ized, and such patients usually haves high mortality. We successfully treat ed a case of aplastic anemia following living-related orthotopic liver tran splantation (LROLT) for non-A, non-B, non-C hepatitis. A 2-yr-old boy with fulminant hepatic failure from non-A, non-B, non-C hepa titis received LROLT. Before transplantation, he had pancytopenia which was probably hepatitis associated, and viral suppression was suspected after b one marrow (BM) biopsy. After the transplantation, he developed progressive pancytopenia and a diagnosis of aplastic anemia was made via BM biopsy. Wi th immunosuppressant agents(cyclosporine, methylprednisolone), cytokine the rapy (granulocyte-colony stimulating factor (G-CSF), macrophage-colony stim ulating factor (M-CSF), recombinant human erythropoietin (rhEPO)) was effec tual and the patient recovered from pancytopenia. Ile was discharged from t he hospital 57 d after the liver transplantation and remains well 1 yr afte r LROLT. Combined cytokine therapy with high doses of G-CSF, M-CSF and rhEP O appeared to be effective in the treatment of aplastic anemia following li ver transplantation for non-A, non-B, non-C hepatitis. Since M-CSF activate s macrophages, it may have contributed to the graft rejection. Careful cons ideration-should be given to the use of high-dose M-CSF in liver transplant patients.