title: Abnormal liver enzymes two years after haematopoietic stem cell transplantation in children: prevalence and risk factors.
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.
authors.affiliation: Department of Paediatric Immunology, Haemato-Oncology, Bone Marrow Transplantation and Auto-immune Diseases, Leiden University Medical Centre, Leiden, The Netherlands. d.bresters@lumc.nl
authors.forename: D
authors.initials: D
authors.lastname: Bresters
authors.forename: I C M
authors.initials: IC
authors.lastname: Van Gils
authors.forename: F W
authors.initials: FW
authors.lastname: Dekker
authors.forename: A C
authors.initials: AC
authors.lastname: Lankester
authors.forename: R G M
authors.initials: RG
authors.lastname: Bredius
authors.forename: J J
authors.initials: JJ
authors.lastname: Schweizer
mesh_terms: D000293:Adolescent; D000410:Alanine Transaminase / Q000097:blood*; D001219:Aspartate Aminotransferases / Q000097:blood*; D002648:Child; D002675:Child, Preschool; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008107:Liver Diseases / Q000209:etiology*; D008297:Male; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors
chemical_list: D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase