1. ¹Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
2. ²Department of Oncology, University of Calgary, Calgary, Alberta, Canada
3. ³Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
4. ⁴Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada

Correspondence: Dr CC Barker, B.C. Children's Hospital, Rm. K4-180, 4480 Oak Street, Vancouver, British Columbia, Canada V6H 3V4. E-mail: cbarker@cw.bc.ca

Received 29 June 2004; Accepted 7 March 2005; Published online 23 May 2005.

Abstract

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.