1. ¹Bone Marrow Transplant Service, Department of Clinical Haematology and Medical Oncology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
2. ²Department of Gastroenterology and Hepatology, Austin and Repatriation Medical Centre, Heidelberg, Victoria, Australia

Correspondence: Dr AP Grigg, C/-Haematology Department, The Royal Melbourne Hospital, Grattan Street, Parkville, Victoria 3050, Australia

Received 19 June 2002; Accepted 23 August 2002.

Abstract

A small number of case reports of steatorrhoea after allogeneic BMT have been published, but the incidence and natural history of this complication have not been defined. We reviewed the incidence of steatorrhoea in 184 consecutive allograft recipients surviving at least 100 days. Steatorrhoea was documented in five patients, a median of 5.5 months (range 4–14) post-transplant. All patients had recent or concomitant acute gut or liver graft versus host disease (GVHD). The probability of developing steatorrhoea by 2 years post-transplant was 3.3% (95% confidence interval (CI) 2.9%) in the group overall, rising to 4.8% (CI 4.2%) in patients with acute and/or extensive chronic GVHD. All patients responded clinically to pancreatic enzyme supplements. While these observations are consistent with previously reported autopsy data suggesting that GVHD of the exocrine pancreas is likely to be the predominant underlying pathological process, in two patients concomitant small bowel or hepatic dysfunction may have contributed to the severity of steatorrhoea. Enzyme supplements were subsequently ceased in three patients without return of steatorrhoea, suggesting that the process is usually reversible. Our data demonstrate that steatorrhoea is not an infrequent complication in the 2 years postallograft, particularly in patients with GVHD.