DISEASE OF THE LIVER FOLLOWING BONE-MARROW TRANSPLANTATION IN CHILDREN - INCIDENCE, CLINICAL COURSE AND OUTCOME IN A LONG-TERM PERSPECTIVE

Sixty-four consecutive cases of allogeneic (n = 16), autologous (n = 4 7) or syngeneic (n = 1) bone marrow transplantation (BMT) in children with haematological or lymphoid malignancy, aplasia or metabolic disea se were reviewed to assess the incidence, clinical presentation and ou tcome of liver disease. Median follow-up time was 5 y (1.0-10). No liv er diagnosis was established at the pre-transplant check-up. During th e first 100 d 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 g raft 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 tran sfusion. Four patients were diagnosed as having chronic GVHD with live r involvement; three of them also had an episode of CMV hepatitis. At their latest follow-up, the patients with chronic GVHD had aminotransf erase values 1.5-3 times the normal, whereas all other long-term survi vors had normal or near-normal liver function tests. We conclude that the incidence of serious liver disease was low in this paediatric popu lation of bone marrow recipients.