Long-term liver dysfunction after allogeneic bone marrow transplantation: clinical features and course in 61 patients

This retrospective study has aimed at determining the prevalence, aetiology and clinical evolution of chronic liver disease (CLD) after allogeneic bon e marrow transplantation (BMT). A total of 106 patients who had been transp lanted in a single institution and who had survived for at least 2 years af ter BMT were studied, The prevalence of CLD was 57.5% (61/106), In 47.3% of cases more than one aetiopathogenic agent coexisted, The causes of CLD wer e iron overload (52.4%), chronic hepatitis C (47.5%), chronic graft-versus- host disease (C-GVHD) (37.7%), hepatitis B (6.5%), non-alcoholic steatohepa titis (NASH) (4.9%), autoimmune hepatitis (AIH) (4.9%) and unknown two (3.3 %). Twenty-three patients with iron overload underwent venesections which m ere well tolerated, tin improvement in liver function tests (LFTs) was obse rved in 21 (91%) patients. All six patients with siderosis as the only caus e of CLD normalized LFT as well as three patients with HCV infection. Clini cal evolution was satisfactory for patients with GVHD, AIH, NASH and hepati tis B, At the last visit 23 patients continued with abnormal LFTs, and 19 o f them were infected by the HCV, A sustained biochemical and virologic resp onse was achieved in only one case out of sis patients with CHC who receive d interferon. We have found that CLD is a common complication in long-term BMT survivors, The aetiology is often multifactorial, iron overload, CHC an d C-GVHD being the main causes. The CLD followed a rather 'benign' and slow course in our patients as none of them developed symptoms or signs of live r failure and we did not observe an increase in morbidity or mortality in t hese patients, but a longer follow-up is necessary in HCV infected patients based on the natural history of this infection in other populations.