Summary:
This retrospective study comprehensively examined hepatic and gastrointestinal complications post-bone marrow transplant (BMT) in a heterogeneous group of 132 pediatric patients that underwent 142 transplants. Hyperbilirubinemia occurred in 28% of this population with clinically evident jaundice in 16%. Acute graft-versus-host disease (GVHD) occurred in 46% of the population, with liver involvement in 39% and intestinal involvement in 60% of those with acute GVHD. Veno-occlusive disease (VOD) occurred in 18% of the population. A greater increase in hepatic transaminases was noted in GVHD and VOD than nonspecific liver injury. Serum bilirubin may help to differentiate between VOD and hepatic GVHD. Biliary sludging occurred in 20% of patients and was associated with increased morbidity. Common post transplant gastrointestinal complications included mucositis in 90%, vomiting in 85% and abdominal pain in 71%. TPN support post transplant was required in 91%. Diarrhea occurred in 67% with the most common identified etiologies reported as GVHD (27%), viral (6%), Clostridium difficile (8%) infections and unknown (28%). Typhilitis developed in 3.5%. Melena or hematochezia occurred in 11 patients (8%). However, gastrointestinal bleeding was disproportionately represented in intensive care unit admissions (5/27) and 100 day mortality (5/21). Gastrointestinal and hepatic complications represent a major cause of morbidity and mortality in pediatric BMT recipients.
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References
Ko CW, Gooley T, Schoch HG et al. Acute pancreatitis in marrow transplant patients: prevalence at autopsy and risk factor analysis. Bone Marrow Transplant 1997; 20: 1081–1086.
Nieto Y, Russ P, Everson G et al. Acute pancreatitis during immunosuppression with tacrolimus following an allogeneic umbilical cord blood transplantation. Bone Marrow Transplant 2000; 26: 109–111.
Akpek G, Valladares JL, Lee L et al. Pancreatic insufficiency in patients with chronic graft-versus-host disease. Bone Marrow Transplant 2001; 27: 163–166.
Or R, Mehta J, Nagler A, Craciun I . Neutropenic enterocolitis associated with autologous bone marrow transplantation. Bone Marrow Transplant 1992; 9: 383–385.
Boggio L, Pooley R, Roth SI, Winter JN . Typhilitis complicating autologous blood stem cell transplantation for breast cancer. Bone Marrow Transplant 2000; 25: 321–326.
Bilgrami S, Feingold HM, Dorsky D et al. Incidence and outcome of Clostridium difficile infection following autologous peripheral blood stem cell transplantation. Bone Marrow Transplant 1999; 23: 1039–1042.
Yolken RH, Bishop CA, Townsend TR et al. Infectious gastroenteritis in bone-marrow-transplant recipients. N Engl J Med 1982; 306: 1009–1012.
Kavan P, Sochor M, Nyc O et al. Pseudomembraneous clostridium after autologous bone marrow transplantation. Bone Marrow Transplant 1998; 21: 521–523.
Perez-Ceballos E, Vallejo C, Cano H et al. Fatal upper and lower gastrointestinal cytomegalovirus disease following autologous peripheral blood stem cell transplantation. Eur J Haematol 2001; 66: 130–132.
Kottaridis PD, Peggs K, Devereux S et al. Simultaneous occurrence of Clostridium difficile and cytomegalovirus colitis in a recipient of autologous stem cell transplantation. Haematologica 2000; 85: 1116–1117.
Holmberg LA, Boeckh M, Hooper H et al. Increased incidence of cytomegalovirus disease after autologous CD34-selected peripheral blood stem cell transplantation. Blood 1999; 94: 4029–4035.
Aljurf M, Gyer M, Alrajhi A et al. Mycobacterium tuberculosis infection in allogeneic bone marrow transplantation patients. Bone Marrow Transplant 1999; 24: 551–554.
Naik HR, Chandrasekar PH . Herpes simplex virus (HSV) colitis in a bone marrow transplant recipient. Bone Marrow Transplant 1996; 17: 285–286.
Chakrabarti S, Collingham KE, Stevens RH et al. Isolation of viruses from stools in stem cell transplant recipients: a prospective surveillance study. Bone Marrow Transplant 2000; 25: 277–282.
Shields AF, Hackman RC, Fife KH et al. Adenovirus infections in patients undergoing bone-marrow transplantation. N Engl J Med 1985; 312: 529–533.
Somervaille TCP, Kirk S, Dogan A et al. Fulminant hepatic failure caused by adenovirus infection following bone marrow transplantation for Hodgkin's disease. Bone Marrow Transplant 1999; 24: 99–101.
Mirza N, Whimbey E, Champlin R et al. Adenovirus infections in adult bone marrow transplant (BMT) recipients. Blood 1995; 86: 218a (Abstr. 859).
Roy V, Weisdorf D . Mycobacterial infections following bone marrow transplant (BMT): a retrospective review of 20 year experience. Blood 1995; 86: 218a (Abstr. 861).
Papadopoulou A, Lloyd DR, Williams MD et al. Gastrointestinal and nutritional sequelae of bone marrow transplantation. Arch Dis Child 1996; 75: 208–213.
Reiss U, Cowan M, McMillan A, Horn B . Hepatic venoocclusive disease in blood and bone marrow transplantation in children and young adults: incidence, risk factors, and outcome in a cohort of 241 patients. J Pediatr Hematol Oncol 2002; 24: 746–750.
Lones MA, Kirov I, Said JW et al. Post-transplant lymphoproliferative disorder after autologous peripheral stem cell transplantation in a pediatric patient. Bone Marrow Transplant 2000; 26: 1021–1024.
Claviez A, Tiemann M, Wagner H-J et al. Epstein–Barr virus-associated post-transplant lymphoproliferative disease after bone marrow transplantation mimicking graft-versus-host disease. Pediatr Transplant 2000; 4: 151–155.
Brugieres L, Hartmann O, Benhamou E et al. Veno-occlusive disease of the liver following high-dose chemotherapy and autologous bone marrow transplantation in children with solid tumors: incidence, clinical course and outcome. Bone Marrow Transplant 1988; 3: 53–58.
Bisogno G, de Kraker J, Weirich A et al. Veno-occlusive disease of the liver in children treated for Wilms tumor. Med Pediatr Oncol 1997; 29: 245–251.
Meresse V, Hartmann O, Vassal G et al. Risk factors for hepatic veno-occlusive disease after high-dose busulfan-containing regimens followed by autologous bone marrow transplantation: a study in 136 children. Bone Marrow Transplant 1992; 10: 135–141.
Carreras E, Bertz H, Arcese W et al. Incidence and outcome of hepatic veno-occlusive disease after blood or marrow transplantation: a prospective cohort study of the European group for blood and marrow transplantation. Blood 1998; 92: 3599–3604.
Locasciulli A, Testa M, Valsecchi MG et al. Morbidity and mortality due to liver disease in children undergoing allogenic bone marrow transplantation: a 10-year prospective study. Blood 1997; 90: 3799–3805.
Ozkaynak MF, Weinberg K, Kohn D et al. Hepatic veno-occlusive disease post-bone marrow transplantation in children conditioned with busulfan and cyclophosphamide: incidence, risk factors, and clinical outcome. Bone Marrow Transplant 1991; 7: 467–474.
Ortega JA, Donaldson SS, Ivy SP et al. Venoocclusive disease of the liver after chemotherapy with vincristine, actinomycin D, and cyclophosphamide for the treatment of rhabdomyosarcoma. Cancer 1997; 79: 2435–2439.
Frisk P, Lonnerholm G, Oberg G . Disease of the liver following bone marrow transplantation in children: incidence, clinical course and outcome in a long-term perspective. Acta Paediatr 1998; 87: 579–583.
Kullendorff CM, Bekassy AN . Hepatic veno-occlusive disease in Wilms' tumor. Eur J Pediatr Surg 1996; 6: 338–340.
Shaw PJ, Hugh-Jones K, Hobbs JR et al. Busulphan and cyclophosphamide cause little early toxicity during displacement bone marrow transplantation in fifty children. Bone Marrow Transplant 1986; 1: 193–200.
Al Otaibi A, Barker C, Anderson R, Sigalet DL . Neutropenic enterocolitis (typhilitis) after bone marrow transplant. J Pediatr Surg 2002; 37: 770–772.
Barker CC, Butzner JD, Anderson RA et al. Incidence, survival and risk factors for the development of veno-occlusive disease in pediatric stem cell transplant recipients. Bone Marrow Transplant 2003; 32: 79–87.
Gudnason T, Belani KK, Balfour Jr HH . Ganciclovir treatment of cytomegalovirus disease in immunocompromised children. Pediatr Infect Dis J 1989; 8: 436–440.
McDonald GB, Sharma P, Matthews DE et al. Venocclusive disease of the liver after bone marrow transplantation: diagnosis, incidence, and predisposing factors. Hepatology 1984; 4: 116–122.
Przepiorka D, Weisdorf D, Martin P . Concensus conference on acute GVHD grading. Bone Marrow Transplant 1995; 15: 825–828.
Werlin SL, Casper J, Antonson D, Calabro C . Pancreatitis associated with bone marrow transplantation in children. Bone Marrow Transplant 1992; 10: 65–69.
Essel JH, Schroeder MT, Harman GS et al. Ursodiol prophylaxis against hepatic complications of allogenic bone marrow transplantation. Ann Intern Med 1998; 128: 975–981.
Ohashi K, Tanabe J, Watanabe R et al. The Japanese multicenter open randomized trial of ursodeoxycholic acid prophylaxis for hepatic veno-occlusive disease after stem cell transplantation. Am J Hematol 2000; 64: 32–38.
Wagner ML, Rosenberg HS, Fernbach DJ, Singleton EB . Typhilitis: a complication of leukemia in childhood. Am J Roentgenol Radium Ther Nucl Med 1970; 109: 341–350.
Shamberger RC, Weinstien HJ, Delorey MJ, Levey RH . The medical and surgical management of typhilitis in children with acute nonlymphocytic (myelogenous) leukemia. Cancer 1986; 57: 603–609.
Schuller I, Saha V, Lin L et al. Investigation and management of Clostridium difficile colonization in a paediatric oncology unit. Arch Dis Child 1995; 72: 219–222.
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Barker, C., Anderson, R., Sauve, R. et al. GI complications in pediatric patients post-BMT. Bone Marrow Transplant 36, 51–58 (2005). https://doi.org/10.1038/sj.bmt.1705004
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DOI: https://doi.org/10.1038/sj.bmt.1705004
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