Biliary obstruction in hematopoietic cell transplant recipients: an uncommon diagnosis with specific causes

Jaundice is a common problem in marrow transplant recipients. The incidence of bile duct obstruction in this setting is unknown. The purpose of this s tudy was to determine the incidence of biliary obstruction, the causes, and outcomes following marrow transplant. Consecutive cases were reviewed at t wo major transplant centers in the United States from 1969 to 1996 at the F red Hutchinson Cancer Research Center and 1989 to 1996 at the City of Hope National Medical Center. Nine cases of biliary obstruction were identified as a cause of jaundice in 7412 marrow transplant recipients, an incidence o f 0.12%. The presentation was bimodal, with seven cases occurring prior to day 100 and two occurring 2 to 4 years after transplantation. The age distr ibution was 15 to 50 years and all patients had received allogeneic transpl ants. The causes of obstruction included gallbladder sludge (n=1), a duoden al hematoma (n=1), choledocholithiasis with biliary pancreatitis (n=1), bil e duct infection (n=2), recurrent malignancy (n=1), choledocholithiasis ass ociated with a benign stricture (n=1), Epstein-Barr virus-related lymphopro liferative disorder (n=1), and a benign stricture of unknown etiology (n=1) , Biliary obstruction is a rare cause of jaundice in the post-transplant pe riod. The presentation was similar to that of other post-transplant hepatob iliary problems, but with disparate causes.