1. ¹Department of Paediatric Immunology, Haemato-Oncology, Bone Marrow Transplantation and Auto-immune Diseases, Leiden University Medical Centre, Leiden, The Netherlands
2. ²Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The Netherlands
3. ³Unit for Paediatric Gastroenterology and Nutrition, Leiden University Medical Centre, Leiden, The Netherlands

Correspondence: Dr D Bresters, Department of Paediatric Immunology, Haemato-Oncology, Bone Marrow Transplantation and Auto-immune Diseases, LUMC, WA-KJC/IHOBA (J6-S), PO Box 9600, Leiden 2300 RC, The Netherlands. E-mail: d.bresters@lumc.nl

Received 19 July 2007; Revised 21 August 2007; Accepted 4 September 2007; Published online 12 November 2007.

Abstract

To establish the prevalence of elevated liver enzymes in children transplanted in a Dutch haematopoietic stem cell transplantation (HSCT) centre, we retrospectively assessed AST and ALT values at 2 years after HSCT. Age, sex, diagnosis, type of transplant, conditioning regimen and early post-transplant complications involving the liver (veno-occlusive disease, acute GVHD, viral reactivation) were analysed as risk factors. AST and ALT values were available at 2 years after HSCT in 216 of 290 patients (75%) alive at that time and were above normal in 53 (25%) and at least twice normal in 17 (8%) patients. Older age at HSCT and a diagnosis of benign haematological disease are risk factors for abnormal liver enzymes late after HSCT. In half of the patients with benign haematological disease, iron overload is the most likely aetiological factor. Chronic hepatitis B or C is uncommon in our centre. In conclusion, the prevalence of abnormal liver enzymes late after HSCT in our centre is lower than reported in previous studies. Abnormal liver enzymes occur more often in children who are older at HSCT and transplanted for benign haematological disease. Long-term follow-up is crucial to establish if elevated liver enzymes precede clinical liver disease.