Incidence, etiology, and risk factors for liver dysfunction in children following hematopoietic stem cell transplantation

: Aims: To identify risk factors which predispose children to develop liver dysfunction (LD) during the initial 100 days following hematopoietic stem cell transplantation (HSCT). Methods: Retrospective analysis of all patients (12 days 4.3 (1.3–14.2), total parenteral nutrition >35 days 8.2 (1.1–66.2), pretransplant ALT >40 U/L 7.4 (0.9–58.6), use of cyclosporine and methotrexate 9.5 (1.2–77.9), and use of amphotericin‐B 3.1 (0.9–10.6). On multivariate analysis only elevated pre transplantation ALT and delayed engraftment were associated with post‐HSCT LD. LD was seen in all 13 patients who died within 100 days following HSCT, and it was felt to be the primary cause of death in six (46%) patients. The factors associated with increased risk of mortality were: allogeneic source of stem cells, delayed engraftment (>18 days), higher mean peak GGT (>250 U/L), and total bilirubin (>6 mg/dL). Conclusion: LD was common and severe in the majority of children following HSCT. Risk of LD was higher in children who had elevated pretransplantation ALT or had delayed engraftment. LD contributes significantly to morbidity and mortality following HSCT.