GI complications in pediatric patients post-BMT

Abstract

Summary:This retrospective study comprehensively examined hepatic and gastrointestinal complications post-bone marrow transplant (BMT) in a heterogeneous group of 132 pediatric patients that underwent 142 transplants. Hyperbilirubinemia occurred in 28% of this population with clinically evident jaundice in 16%. Acute graft-versus-host disease (GVHD) occurred in 46% of the population, with liver involvement in 39% and intestinal involvement in 60% of those with acute GVHD. Veno-occlusive disease (VOD) occurred in 18% of the population. A greater increase in hepatic transaminases was noted in GVHD and VOD than nonspecific liver injury. Serum bilirubin may help to differentiate between VOD and hepatic GVHD. Biliary sludging occurred in 20% of patients and was associated with increased morbidity. Common post transplant gastrointestinal complications included mucositis in 90%, vomiting in 85% and abdominal pain in 71%. TPN support post transplant was required in 91%. Diarrhea occurred in 67% with the most common identified etiologies reported as GVHD (27%), viral (6%), Clostridium difficile (8%) infections and unknown (28%). Typhilitis developed in 3.5%. Melena or hematochezia occurred in 11 patients (8%). However, gastrointestinal bleeding was disproportionately represented in intensive care unit admissions (5/27) and 100 day mortality (5/21). Gastrointestinal and hepatic complications represent a major cause of morbidity and mortality in pediatric BMT recipients.

Higher CD3+ and CD34+ cell doses in the graft increase the incidence of acute GVHD in children receiving BMT for thalassemia

“…37,38 Marrow transplant recipients may be predisposed to developing pancreatitis because of biliary sludge, use of irradiation or cytotoxic drugs in the conditioning regimen, prolonged medication with corticosteroids and CSA, and viral infections. 39,40 Our data do not show a relation of pancreatitis to these factors, although in three patients adenovirus was detected in stool and/or gastric secretion only during the course of aGVHD. As these patients were on combined immunosuppressive treatment, it is unclear whether reactivation of adenovirus in gastrointestinal tract was a consequence of immunosuppression or whether it caused pancreatitis.…”

Prognostic Factors in the Resumption of Oral Dietary Intake After Allogeneic Hematopoietic Stem Cell Transplantation (HSCT) in Children

“…The impact of GVHD specifically on oral intake has not been well studied but is known to cause significant nutrition-related problems in children and adults. 10,21 In a cohort of 18 children with multiorgan GVHD, a mean decrease in BMI of 20.9% was noted from HSCT date to the lowest BMI recorded. 22 We were unable to document a relationship between donor type and oral dietary intake.…”

Acute gut GVHD in children: does skin involvement matter?

“…Barker et al 9 examined gut complications following SCT in a heterogeneous group of 132 pediatric patients that underwent 142 transplants. Acute GVHD was most commonly diagnosed in conjunction with skin manifestations.…”