Abnormal liver function tests following bone marrow transplantation: aetiology and role of liver biopsy.
BACKGROUND
Liver dysfunction is common in bone marrow transplant recipients. Common causes are graft-versus-host disease, drugs, veno-occlusive disease, sepsis and iron overload. We studied the prevalence and aetiology of abnormal liver function tests following bone marrow transplantation and the role of liver biopsy.


METHODS
All allogeneic and autologous bone marrow transplantations undertaken in our institution over a 2-year period were studied. Subsequent liver function tests, the use and timing of liver biopsy and the final cause of liver dysfunction were determined in each case.


RESULTS
We studied 121 patients (58 allogeneic, 63 autologous). Abnormal liver function tests were found in 52% of bone marrow transplant recipients (72% allogeneic and 33% autologous; P = 0.015). The most common causes of liver dysfunction were graft-versus-host disease, drugs and iron overload in the allogeneic group, and drugs and sepsis in the autologous group. Nineteen patients (16%; 18 allogeneic) underwent liver biopsy. The majority of liver biopsies were carried out in the late post-transplant period to exclude or confirm graft-versus-host disease, although only one case was confirmed. Sixteen of the 19 patients who underwent biopsy had significant hepatic iron overload, but no biopsy revealed evidence of fibrosis or cirrhosis.


CONCLUSIONS
Liver dysfunction following bone marrow transplantation is common and most diagnoses can be ascertained without resorting to liver biopsy. In our series, hepatic iron overload was the most common finding in those who underwent liver biopsy.
Ho
Gwo-Tzer
GT
Department of Gastroenterology, Glasgow Royal Infirmary, Glasgow, UK.
Parker
Anne
A
MacKenzie
John F
JF
Morris
A John
AJ
Stanley
Adrian J
AJ
D000328:Adult; D000368:Aged; D001706:Biopsy / Q000379:methods; D016026:Bone Marrow Transplantation / Q000009:adverse effects*; D056486:Chemical and Drug Induced Liver Injury; D005260:Female; D005293:Ferritins / Q000097:blood; D005838:Genotype; D006086:Graft vs Host Disease / Q000150:complications / Q000503:physiopathology; D006432:Hemochromatosis / Q000150:complications; D006801:Humans; D007501:Iron / Q000378:metabolism; D008099:Liver / Q000378:metabolism / Q000473:pathology / Q000503:physiopathology*; D008107:Liver Diseases / Q000209:etiology* / Q000473:pathology; D008111:Liver Function Tests / Q000379:methods; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018805:Sepsis / Q000150:complications; D012720:Severity of Illness Index; D013997:Time Factors; D014168:Transferrin / Q000032:analysis; D014182:Transplantation, Autologous
D014168:Transferrin; D005293:Ferritins; D007501:Iron