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Blood, Vol. 93 No. 10 (May 15), 1999:
pp. 3259-3266
Cirrhosis of the Liver in Long-Term Marrow Transplant Survivors
Simone I. Strasser,
Keith M. Sullivan,
David Myerson,
Catherine L. Spurgeon,
Barry Storer,
H. Gary Schoch,
Carol S. Murakami, and
George
B. McDonald
From Gastroenterology/Hepatology, Long-Term Follow-Up and Clinical
Statistics Sections of the Fred Hutchinson Cancer Research Center, and
the University of Washington School of Medicine, Seattle, WA.
Patients who survive hematopoietic cell transplantation (HCT) have
multiple risk factors for chronic liver disease, including hepatitis
virus infection, iron overload, and chronic graft-versus-host disease
(GVHD). We studied 3,721 patients who had survived 1 or more years
after HCT at a single center and identified patients with histologic or
clinical evidence of cirrhosis. Risk factors for the development of
cirrhosis were evaluated and compared with a group of matched
control subjects. Cirrhosis was identified in 31 of 3,721 patients
surviving 1 or more years after HCT, 23 of 1,850 patients surviving 5 or more years, and in 19 of 860 patients surviving 10 or more years.
Cumulative incidence after 10 years was estimated to be 0.6% and after
20 years was 3.8%. The median time from HCT to the diagnosis of
cirrhosis was 10.1 years (range, 1.2 to 24.9 years). Twenty-three
patients presented with complications of portal hypertension, and 1 presented with hepatocellular carcinoma. Thirteen patients have died
from complications of liver disease, and 2 died of other causes. Three
patients have undergone orthotopic liver transplantation. Hepatitis C
virus infection was present in 25 of 31 (81%) of patients with
cirrhosis and in 14 of 31 (45%) of controls (P = .01).
Cirrhosis was attibutable to hepatitis C infection in 15 of 16 patients
presenting more than 10 years after HCT. There was no difference in the
prevalence of acute or chronic GVHD, duration of posttransplant
immunosuppression, or posttransplant marrow iron stores between cases
and controls. Cirrhosis is an important late complication of
hematopoietic cell transplantation and in most cases is due to chronic
hepatitis C. Long-term survivors should be evaluated for the presence
of abnormal liver function and hepatitis virus infection.
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