The role of hepatitis C and B virus infections as risk factors for severe liver complications following allogeneic BMT: A prospective study by the Infectious Disease Working Party of the European Blood and Marrow Transplantation Group

Background Severe liver disease, including fulminant hepatic failure and ve noocclusive disease can occur after bone marrow transplantation (BMT). The aim of our study was to assess risk factors for veno occlusive disease and severe liver disease occurring within 6 months from BMT. Methods. A total of 193 consecutive patients from 15 BMT Centers were prosp ectively enrolled between January and June 1995. Data on donors and recipie nts before and after transplant were collected and included age, gender, al anine amiotransferase (ALT), hepatitis B (HBV), and hepatitis C virus (HCV) markers, hematological;sal disease, status and type of BMT, conditioning r egimen and graft versus host disease prophylaxis. Statistical analysis incl uded univariate; descriptive and multivariate analysis based on logistic re gression on major end-points. Results Forty-three of 193 patients died during the study period, and liver disease was the main cause of death (13 of 43, 30%). Incidence of severe v eno occlusive disease was 8%, fulminant hepatic failure 0.5% and 12% of cas es had ALT >500 U/L (normal less than or equal to 42 U/L). A de novo HBV or HCV infection occurred in 3.2 and 7% of patients respectively. Predictive risk factors for life threatening liver disease were: unrelated donors (rel ative risk=5.8, confidence interval=1.7-19.8) and abnormal BMT donor ALT (r elative risk=6.3, confidence interval=1.5-25.5). Conclusions. This study indicates that ongoing or previous infection with H BV or HCV in donor or recipient is not an absolute contraindication for BMT . However, abnormal ALT levels in BMT donors were a significant predictor o f potentially lethal liver complications. The occurrence of de novo HBV or HCV infection did not correlate with severity of liver disease observed in the first 6 months posttransplant. These findings should be carefully evalu ated before disregarding HBV or HCV positive siblings with normal transamin ase levels in favor of unrelated donors.