Fulminant hepatitis is significantly increased in hepatitis B carriers after allogeneic bone marrow transplantation.
BACKGROUND
Bone marrow transplantation (BMT) is effective treatment for many hematologic disease, but performed in a population with a high endemic hepatitis B virus carrier rate, the incidence of liver function impairment and fulminant hepatitis (FH) is expected to be raised.


METHODS
Forty-three hepatitis B virus carriers received high-dose chemotherapy and BMT, 32 patients received an allogeneic graft, and 11 patients autologous marrow. Acute graft-versus-host disease prophylaxis consisted of methotrexate on day 1, 3, 6, and 11 and cyclosporine for 6 months.


RESULTS
After a median follow-up period of 68 months (range: 1-11.5 years), 26 (81.3%) allogeneic BMT patients developed impaired liver function (LF), 5 progressed to FH on day 93, 169, 170, 180, and 468, respectively, and died after an average of 13.8 days (range: 1-45 days). Whereas only 4 (36.4%) autologous BMT patients developed impaired LF, and none FH. Impaired LF (P=0.026, chi-square), and FH (odds ratio=12.86, P=0.009 for coefficient) were significantly related to an allogeneic marrow graft, and the timing of liver function impairment coincided with cyclosporine withdrawal. Hepatitis B surface antigen (HbsAg) disappeared from the serum in 4/14 (28.6%) patients receiving a marrow graft from an HbsAg+ donor. HbsAg was not detected in the serum after BMT in 2/11 (18.2%) autologous BMT patients.


CONCLUSIONS
Hepatitis B virus carriers receiving a marrow graft from an HbsAg+ donor have a significantly increased risk of FH.
Chen
P M
PM
Department of Medicine, Veterans General Hospital, Taipei, Taiwan, Republic of China. pmchen@vghtpe.gov.tw
Chiou
T J
TJ
Fan
F S
FS
Liu
J M
JM
Hsieh
R K
RK
Yen
C C
CC
Wang
W S
WS
Liu
J H
JH
D000293:Adolescent; D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D000704:Analysis of Variance; D000914:Antibodies, Viral / Q000097:blood; D016026:Bone Marrow Transplantation / Q000009:adverse effects*; D002353:Carrier State / Q000276:immunology / Q000821:virology*; D002423:Cause of Death; D002648:Child; D005260:Female; D016174:Hepacivirus / Q000276:immunology; D006505:Hepatitis / Q000209:etiology*; D006508:Hepatitis Antibodies / Q000097:blood; D006509:Hepatitis B / Q000276:immunology / Q000635:transmission*; D006514:Hepatitis B Surface Antigens / Q000097:blood; D006515:Hepatitis B virus / Q000276:immunology; D006801:Humans; D008111:Liver Function Tests; D008297:Male; D016019:Survival Analysis; D014182:Transplantation, Autologous / Q000009:adverse effects / Q000401:mortality; D014184:Transplantation, Homologous / Q000401:mortality
D000914:Antibodies, Viral; D006508:Hepatitis Antibodies; D006514:Hepatitis B Surface Antigens; D000410:Alanine Transaminase