Hematologic abnormalities in liver-transplanted children during medium- to long-term follow-up

Iglesias-Berengue, Juan; López-Espinosa, J.A; Ortega-López, J; Sánchez‐Sánchez, Luz María; Asensio-Llorente, Marino; Margarit-Creixell, Carlos; Díaz-Heredia, Cristina

doi:10.1016/s0041-1345(03)00589-x

Cited by 7 publications

(5 citation statements)

References 6 publications

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“…It is also the largest pediatric study to report the risk factors, some of which have not been previously described, associated with chronic anemia in this population. We found that chronic anemia is common among children during the first five yr post‐transplant, with a prevalence of 24% in our analysis similar to that reported in other pediatric studies (11, 12). We relied on stringent criteria dependent on two consecutive hemoglobin values at least six months apart on follow‐up to define chronic anemia and to establish cases in our analysis, thereby minimizing the effect of interval illnesses or temporary circumstances that might result in transient decreases in hemoglobin.…”

Section: Discussionsupporting

confidence: 90%

“…Some of these risk factors for chronic anemia, such as poor renal function and medication toxicity, are well described in the general pediatric and adult transplant literature (3–7, 10, 11, 15). Others, such as leukopenia and age, represent novel risk factors not previously identified.…”

Section: Discussionmentioning

confidence: 99%

“…In a recent adult cohort, the prevalence of anemia, defined by World Health Organization criteria of hemoglobin <13 g/dL for men and <12 g/dL for women, reached 50% and 53% at 6 and 12 months post–liver transplant, respectively (10). Data regarding chronic anemia in pediatric recipients of liver transplants are limited as well, although the reported prevalence ranges from 20% to 28% in recent small, retrospective studies (11, 12). The risk factors associated with persistent anemia post–liver transplant are not well established, but poor renal function, iron‐restricted erythropoiesis as well as marrow suppression from chronic infection or medications are believed to play a role, as in renal transplant recipients (13).…”

mentioning

confidence: 99%

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Risk factors for chronic anemia in pediatric orthotopic liver transplantation: Analysis of data from the SPLIT registry

Liem

Anand

Yin

et al. 2011

Pediatric Transplantation

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Risk factors for chronic anemia in the post transplant period have not been clearly delineated in pediatric liver transplant recipients. We analyzed data from children transplanted from 2000 to 2008 with at least 2 consecutive hemoglobin values from follow-up between 6 months and 5 years post transplant. A multivariate model was derived to determine independent risk factors associated with chronic anemia. Of 1026 children in this analysis, 242 (23.6%) were found to have chronic anemia. On multivariate analysis, GI bleeding (OR 11.83 [2.08-67.49], P = 0.0054), presence of leukopenia (OR 9.55 [95% CI 3.71-24.62], P < 0.0001), use of cyclosporine (OR 3.69, [95% CI 1.56-8.76], P = 0.0039) and corticosteroids (OR 2.90 [95% CI 1.94-4.33], P < 0.0001), and calculated GFR < 90 mL/min/1.73m2 (OR 4.62 [95% CI 2.47-8.67], P < 0.0001) represented the most significant risk factors for chronic anemia. Use of anti-hypertensive medications (OR 1.89 [95% CI 1.23-2.91], P = 0.0039) was also significantly associated with a higher risk. In summary, chronic anemia is common in children following liver transplant. Our findings underscore the need to define the mechanisms by which these risk factors, some of which are modifiable, result in chronic anemia in pediatric liver transplant recipients.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Risk factors for chronic anemia in pediatric orthotopic liver transplantation: Analysis of data from the SPLIT registry

Liem

Anand

Yin

et al. 2011

Pediatric Transplantation

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“…Thrombocytopenia commonly develops in the early period after LT, and most patients recover with the restoration of hepatic function. Pretransplant long‐lasting thrombocytopenia may persistent in some cases after LT (2). Severe thrombocytopenia resulting in bleeding complications after LT may lead to increased morbidity and mortality (3).…”

mentioning

confidence: 99%

Factors predicting persistent thrombocytopenia after living donor liver transplantation in pediatric patients

Honda

Yamamoto

Hayashida

et al. 2011

Pediatric Transplantation

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Thrombocytopenia is common after LT for pediatric end-stage liver diseases. Seventy-six pediatric patients (≤15 yr old) who underwent LDLT were evaluated for the incidence and predictive factors of post-transplant thrombocytopenia (PLT <100, 000/mm(3) ). The prevalence of thrombocytopenia at two wk and at 12 months post-transplant was 22/76 (28.9%) and 11/62 (17.7%), respectively. Thrombocytopenia at two wk after LDLT was significantly associated with age at transplant, preoperative PLT, GRWR, acute rejection, and CMV infection in univariate analysis. Moreover, preoperative PLT, GRWR, and acute rejection had a strong correlation in multivariate analysis. Thrombocytopenia at 12 months after LDLT was associated only with preoperative PLT. We also demonstrated that vascular complications caused thrombocytopenia and that successful treatment recovered the PLT. These results showed that, in addition to considering the preoperative PLT, post-operative monitoring of platelets is very helpful for the early detection of adverse events related to the graft liver in pediatric liver transplant patients.

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“…Neutropenia is also commonly encountered post-OLT, with an incidence of 13% in one report. 85 The etiology of neutropenia post-OLT is similar to that of HIV with myelosuppressive medications and bone marrow infiltration figuring most prominently. Less common causes of anemia and neutropenia post-OLT include graft versus host disease and blood group (ABO)-incompatibility, which induce an immunologically mediated hemolytic anemia.…”

Section: Anemia and Neutropenia Post-liver Transplantationmentioning

confidence: 99%

Role of Growth Factors in the Treatment of Patients With HIV/HCV Coinfection and Patients With Recurrent Hepatitis C Following Liver Transplantation

Fredrick

Hassanein

2005

Journal of Clinical Gastroenterology

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Hepatitis C (HCV) contributes significantly to the morbidity and mortality of patients coinfected with human immunodeficiency virus (HIV) and those with recurrent hepatitis C after successful liver transplantation. Treatment of hepatitis C in these patient populations, while crucial, can be quite challenging. Baseline cytopenias, in particular, may limit dosing of interferon and/or ribavirin or preclude therapy entirely when standard guidelines are followed. Concomitant medications, opportunistic infections, and other bone marrow insults account for the anemia, neutropenia, and thrombocytopenia frequently encountered in these patients. Sustained virologic response rates in published series for HIV/HCV and post-transplantation HCV have not reached those seen in treatment of HCV alone, despite the highly selected patient populations chosen for these studies. Hematopoietic growth factors such as erythropoietin and granulocyte-colony stimulating factors may be used to improve the anemia and neutropenia seen during treatment of HCV. Reported experience with these growth factors is limited in HIV/HCV coinfected patients, but studies are underway to determine if growth factors improve adherence to therapy and perhaps virologic response rates. Post-transplantation studies of HCV therapy have reported more liberal use of growth factors; however, discontinuation rates have been high and virologic response rates have been disappointing. Further study of growth factors as a means to increase sustained virologic response rates and maintain adequate dosing and duration of interferon and ribavirin therapy in these patient populations is needed.

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Hematologic abnormalities in liver-transplanted children during medium- to long-term follow-up

Cited by 7 publications

References 6 publications

Risk factors for chronic anemia in pediatric orthotopic liver transplantation: Analysis of data from the SPLIT registry

Risk factors for chronic anemia in pediatric orthotopic liver transplantation: Analysis of data from the SPLIT registry

Factors predicting persistent thrombocytopenia after living donor liver transplantation in pediatric patients

Role of Growth Factors in the Treatment of Patients With HIV/HCV Coinfection and Patients With Recurrent Hepatitis C Following Liver Transplantation

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