Abnormal liver function tests following bone marrow... : European Journal of Gastroenterology & Hepatology (original) (raw)

Original articles: Liver

aetiology and role of liver biopsy

Ho, Gwo-Tzera; Parker, Anneb; MacKenzie, John Fa; Morris, A Johna; Stanley, Adrian Ja

aDepartment of Gastroenterology and bBone Marrow Transplant Unit, Glasgow Royal Infirmary, Glasgow, UK.

Correspondence to Dr A.J. Stanley, Consultant Gastroenterologist, c/o Ward 9, Glasgow Royal Infirmary, 84 Castle St, Glasgow G4 0SF, UK. Tel: +44 141 211 4073; fax: +44 141 211 5131

Received 15 October 2002 Accepted 10 September 2003

Abstract

Introduction

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.

Conclusion

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.