title: HLA, GVHD, and parenteral nutrition are risk factors for hepatic complications in pediatric HSCT.
abstract: Hepatic dysfunction is common after allogeneic hematopoietic stem cell transplantation (HSCT). The aim of this retrospective study was to determine the risk factors, frequency, and outcome of hepatic complications post-HSCT in children. Two hundred and thirty-seven cases of allogeneic HSCT in children were included. Data on biochemical liver function at start of HSCT, at +1, +3, +6, and +9 months, and at each subsequent yearly follow-up were extracted. Patients were stratified into groups with hepatocellular (none and mild, and moderate to severe) and hepatobiliary (none and present) dysfunction. Statistical analysis included variables such as diagnosis, age, conditioning regimen, and HLA type.
  
  
  RESULTS
  One hundred and fifty-six (66%) patients displayed hepatocellular dysfunction post-HSCT. In most cases transient, but 32% had a persistent abnormality three yr post-HSCT. Risk factors were chronic GVHD (OR 4.20, p = 0.003) and donor HLA-A*01 (OR 2.97, p = 0.02). HLA-DQB1*03 decreased the risk (OR 0.35, p = 0.02). Hepatobiliary dysfunction was less frequent (12%) but carried a poor prognosis. aGVHD grade II-IV (OR 2.7, p = 0.02) and long-term TPN (OR 3.25, p = 0.01) increased the risk.
  
  
  CONCLUSIONS
  GVHD is an important risk factor for liver dysfunction post-HSCT. Specific HLA types may also contribute as a risk factor, while others seem to have a protective effect.
authors.affiliation: Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Linda
authors.initials: L
authors.lastname: Thorvaldson
authors.affiliation: Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.|Center for Allogeneic Stem Cell Transplantation, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Mats
authors.initials: M
authors.lastname: Remberger
authors.affiliation: Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.|Hematology, Immunology and SCT Section, Astrid Lindgren Children's Hospital, Stockholm, Sweden.
authors.forename: Jacek
authors.initials: J
authors.lastname: Winiarski
authors.affiliation: Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.|Department of Clinical Immunology and Transfusion Medicine, Karolinska University Laboratory, Karolinska University Hospital Huddinge, Stockholm, Sweden.
authors.forename: Brigitta
authors.initials: B
authors.lastname: Omazic
authors.affiliation: Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.|Gastroenterology, Hepatology and Nutrition Section, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Björn
authors.initials: B
authors.lastname: Fischler
authors.affiliation: Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.|Hematology, Immunology and SCT Section, Astrid Lindgren Children's Hospital, Stockholm, Sweden.
authors.forename: Mikael
authors.initials: M
authors.lastname: Sundin
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006086:Graft vs Host Disease / Q000150:complications / Q000175:diagnosis*; D006680:HLA Antigens / Q000235:genetics*; D015234:HLA-A Antigens / Q000235:genetics; D059866:HLA-DQ beta-Chains / Q000235:genetics; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D007223:Infant; D017093:Liver Failure / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D008297:Male; D010289:Parenteral Nutrition, Total / Q000009:adverse effects*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous / Q000009:adverse effects; D016896:Treatment Outcome
chemical_list: D006680:HLA Antigens; D015234:HLA-A Antigens; D059866:HLA-DQ beta-Chains; C069051:HLA-DQB1 antigen
keywords: child; graft versus host disease; hematopoietic stem cell transplantation; human leukocyte antigen; liver