The role of hepatitis C and B virus infections as risk factors for severe liver complications following allogeneic BMT: a prospective study by the Infectious Disease Working Party of the European Blood and Marrow Transplantation Group.
BACKGROUND
Severe liver disease, including fulminant hepatic failure and venoocclusive disease can occur after bone marrow transplantation (BMT). The aim of our study was to assess risk factors for veno occlusive disease and severe liver disease occurring within 6 months from BMT.


METHODS
A total of 193 consecutive patients from 15 BMT Centers were prospectively enrolled between January and June 1995. Data on donors and recipients before and after transplant were collected and included age, gender, alanine aminotransferase (ALT), hepatitis B (HBV), and hepatitis C virus (HCV) markers, hematological disease, status and type of BMT, conditioning regimen and graft versus host disease prophylaxis. Statistical analysis included univariate descriptive and multivariate analysis based on logistic regression on major end-points.


RESULTS
Forty-three of 193 patients died during the study period, and liver disease was the main cause of death (13 of 43, 30%). Incidence of severe veno occlusive disease was 8%, fulminant hepatic failure 0.5% and 12% of cases had ALT >500 U/L (normal < or =42 U/L). A de novo HBV or HCV infection occurred in 3.2 and 7% of patients respectively. Predictive risk factors for life-threatening liver disease were: unrelated donors (relative risk=5.8, confidence interval=1.7-19.8) and abnormal BMT donor ALT (relative risk=6.3, confidence interval=1. 5- 25.5).


CONCLUSIONS
This study indicates that ongoing or previous infection with HBV or HCV in donor or recipient is not an absolute contraindication for BMT. However, abnormal ALT levels in BMT donors were a significant predictor of potentially lethal liver complications. The occurrence of de novo HBV or HCV infection did not correlate with severity of liver disease observed in the first 6 months posttransplant. These findings should be carefully evaluated before disregarding HBV or HCV positive siblings with normal transaminase levels in favor of unrelated donors.
Locasciulli
A
A
Clinica Pediatrica Università di Milano, Ematologia Pediatrica, Ospedal San Gerardo, Monza (Milano), Itlay.
Testa
M
M
Valsecchi
M G
MG
Bacigalupo
A
A
Solinas
S
S
Tomas
J F
JF
Ljungman
P
P
Alberti
A
A
D000293:Adolescent; D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D000704:Analysis of Variance; D016026:Bone Marrow Transplantation / Q000276:immunology / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005060:Europe; D005260:Female; D006509:Hepatitis B / Q000453:epidemiology* / Q000635:transmission; D006510:Hepatitis B Antibodies / Q000097:blood; D006526:Hepatitis C / Q000453:epidemiology* / Q000635:transmission; D018937:Hepatitis C Antibodies / Q000097:blood; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods; D007223:Infant; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000453:epidemiology*; D011446:Prospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D014184:Transplantation, Homologous
D006510:Hepatitis B Antibodies; D018937:Hepatitis C Antibodies; D000410:Alanine Transaminase