title: Liver disease is a major cause of mortality following allogeneic bone-marrow transplantation.
abstract: BACKGROUND
  Liver disease is an important cause of morbidity and mortality among recipients of bone-marrow transplantation (BMT). The aim of this retrospective study was to determine the incidence, risk factors and clinical evolution of liver disease following allogeneic BMT.
  
  
  METHODS
  A total of 103 patients (mean age 22.8 years (SD 10.9); 31.1% aged < 18 years; 66% males) transplanted in a single institution were enrolled. Data on donors and recipients were collected, including hematological disease, alanine transaminase, alkaline phosphatase, bilirubin, hepatitis B virus (HBV) and hepatitis C virus (HCV) markers (including HBV-DNA and HCV-RNA).
  
  
  RESULTS
  Fifty six of 103 patients died, with liver disease the main cause of death (27 of 56, 48%). Overall the incidence of liver failure attributed to hepatic graft-versus-host-disease (GVHD) was 22.3% (23 of 103; 74% HBV/HCV infected) and veno-occlusive disease (VOD) was 9.7% (10 of 103; 80% HBV/HCV infected). Fourteen patients had hepatitis reactivations (four hepatic GVHD and three VOD). Donors' HCV-RNA status and serum bilirubin above 2 mg/dl were predictive of hepatic GVHD [adjusted odds ratio (AOR) 11.1, 95% confidence interval (CI) 0.99-33.12; AOR 3.93, 95% CI 1.09-14.62; P < 0.05, respectively] and an abnormal alkaline phosphatase could predict severe liver disease (AOR 2.78, 95% CI 1.01-7.54; P < 0.05). Development of severe liver disease (hepatic GVHD or VOD) was a significant predictor of mortality (AOR 4.57, 95% CI 1.09-20.32; P < 0.05) with a low probability of survival (19.3%, SD 7.9%) compared with those without liver disease (52.1%, SD 7.6%; log-rank P = 0.0003).
  
  
  CONCLUSIONS
  Hepatic GVHD is a common complication following BMT and an important cause of liver-related mortality. The high prevalence of HCV and HBV may have contributed to the outcome of hepatic GVHD and VOD. Therefore, antiviral therapy should be considered early to prevent relentless progression of liver disease.
authors.affiliation: Pediatric Department, Hematology/Oncology Division, Children's Hospital, Ain Shams University, Cairo, Egypt. manalhelsayed@yahoo.com
authors.forename: Manal H
authors.initials: MH
authors.lastname: El-Sayed
authors.forename: Alaa
authors.initials: A
authors.lastname: El-Haddad
authors.forename: Omar A
authors.initials: OA
authors.lastname: Fahmy
authors.forename: Iman I
authors.initials: II
authors.lastname: Salama
authors.forename: Hossam K
authors.initials: HK
authors.lastname: Mahmoud
mesh_terms: D000293:Adolescent; D000328:Adult; D001663:Bilirubin / Q000097:blood; D016026:Bone Marrow Transplantation / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006086:Graft vs Host Disease / Q000209:etiology / Q000401:mortality; D016174:Hepacivirus / Q000302:isolation & purification; D006504:Hepatic Veno-Occlusive Disease / Q000209:etiology / Q000401:mortality; D006505:Hepatitis / Q000209:etiology / Q000401:mortality; D006515:Hepatitis B virus / Q000302:isolation & purification; D006801:Humans; D008107:Liver Diseases / Q000209:etiology / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012367:RNA, Viral / Q000097:blood; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D014184:Transplantation, Homologous
chemical_list: D012367:RNA, Viral; D001663:Bilirubin