title: Gallstones in pediatric hematopoietic cell transplant survivors with up to 40 years of follow-up.
abstract: OBJECTIVE
  To determine risk factors for the development of gallstones and the prevalence of related cholecystectomy in children following hematopoietic cell transplantation (HCT).
  
  
  METHODS
  A retrospective chart review of 1343 patients aged below 18 years old who survived at least 1 year after HCT from 1969 to 2011 was performed. Multivariate Cox regression models were used to estimate the hazard ratio (HR) of risk factors associated with gallstones.
  
  
  RESULTS
  Gallstones developed in 91 patients, a median of 3.5 (range, 0.1 to 30.9) years after HCT at 16.3 (range, 0.8 to 44.2) years of age, with a 40-year cumulative incidence of 11%. At initial diagnosis, 61 (67%) patients were symptomatic and 30 (23%) had incidental gallstones. Risk factors associated with gallstones included autologous transplant (HR=2.7, P=0.02), unrelated donor (HR=2.0, P=0.05), grade 3 to 4 acute graft-versus-host disease (GVHD) (HR=2.2, P=0.03), chronic GVHD (HR=2.0, P=0.05), second transplant (HR=2.3, P=0.03), diabetes (HR=2.2, P=0.05), and estrogen therapy (HR=1.8, P=0.03). Fifty-six patients underwent cholecystectomy. The prevalence of cholecystectomy among 853 surviving patients was 5.2%.
  
  
  CONCLUSIONS
  Childhood HCT patients have an increased risk of developing gallstones.
authors.affiliation: *Clinical Research Division, Fred Hutchinson Cancer Research Center Departments of ‡Pediatrics †Medicine, University of Washington School of Medicine, Seattle, WA.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Hoffmeister
authors.forename: Barry E
authors.initials: BE
authors.lastname: Storer
authors.forename: George B
authors.initials: GB
authors.lastname: McDonald
authors.forename: K Scott
authors.initials: KS
authors.lastname: Baker
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002763:Cholecystectomy / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D042882:Gallstones / Q000453:epidemiology* / Q000209:etiology*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects* / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D015999:Multivariate Analysis; D015995:Prevalence; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D017741:Survivors / Q000706:statistics & numerical data*