Cirrhosis of the liver in long-term marrow transplant survivors

Patients who survive hematopoietic cell transplantation (HCT) have multiple risk factors for chronic liver disease, including hepatitis virus infectio n, iron overload, and chronic graft-versus-host disease (GVHD). We studied 3,721 patients who had survived 1 or more years after HCT at a single cente r and identified patients with histologic or clinical evidence of cirrhosis . Risk factors for the development of cirrhosis were evaluated and compared with a group of matched control subjects. Cirrhosis was identified in 31 o f 3,721 patients surviving 1 or more years after HCT, 23 of 1,850 patients surviving 5 or more years, and in 19 of 860 patients surviving 10 or more y ears. Cumulative incidence after 10 years was estimated to be 0.6% and afte r 20 years was 3.8%. The median time from HCT to the diagnosis of cirrhosis was 10.1 years (range, 1.2 to 24.9 years). Twenty-three patients presented with complications of portal hyper-tension, and 1 presented with hepatocel lular carcinoma. Thirteen patients have died from complications of liver di sease, and 2 died of other causes. Three patients have undergone orthotopic liver transplantation. Hepatitis C virus infection was present in 25 of 31 (81%) of patients with cirrhosis and in 14 of 31 (45%) of controls (P = .0 1). Cirrhosis was attibutable to hepatitis C infection in 15 of 16 patients presenting more than 10 years after HCT. There was no difference in the pr evalence of acute or chronic GVHD, duration of posttransplant immunosuppres sion, or posttransplant marrow iron stores between cases and controls. Cirr hosis is an important late complication of hematopoietic cell transplantati on and in most cases is due to chronic hepatitis C. Long-term survivors sho uld be evaluated for the presence of abnormal liver function and hepatitis virus infection. (C) 1999 by The American Society of Hematology.