Aplastic anemia complicating orthotopic liver transplantation

John A. Goss, Gary J. Schiller, Paul Martin, Philip Seu, Rise Stribling, Sue V. Mcdiarmid, Christopher R. Shackleton, Jay S. Markowitz, Barbara J. Nuesse, Leonard I. Goldstein, Ronald W. Busuttil

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Abstract

The clinical characteristics and outcome of posttransplantation aplastic anemia (AA) were determined in 12 of 1,736 patients (0.007%) undergoing orthotopic liver transplantation (OLT) that were afflicted with AA. None of the affected patients had a history of hematologic disease. Median patient age was 53 years (range, 2-61 years); 10 of the affected patients were men, and 2 were women. The etiologies of AA included non-A, non-B, non-C fulminant hepatic failure (FHF) (3 patients), graft-versus-host disease (4 patients), Parvovirus-induced (1 patient), and idiopathic (4 patients). The median duration between OLT and the onset of AA was 12 days (range, 11-14 days) in the 3 patients undergoing OLT for FHF; in contrast, AA developed in the other 9 patients at 37 days (range, 27-51 days) after OLT. Eleven patients were treated with reduction of their cyclosporine or tacrolimus dosage, granulocyte colony-stimulating factor, anti-thymocyte globulin, and Solumedrol. Two of the 3 patients developing AA following OLT for FHF achieved hematologic recovery 21 and 92 days after diagnosis. In contrast, all 9 non-FHF patients developing AA after OLT died, 5 due to infectious complications and 4 following intracranial bleeding. AA is an unusual complication of OLT. In the setting of FHF, it affects young males in the early posttransplantation period, and, when infectious complications can be avoided, remission and stable allograft function can be anticipated. However, in the non-FHF patient, AA occurs in older individuals later in the posttransplantation period and has a uniformly poor outcome.

Original languageEnglish
Pages (from-to)865-869
Number of pages5
JournalHepatology
Volume26
Issue number4
StatePublished - Oct 1 1997
Externally publishedYes

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Aplastic Anemia
Liver Transplantation
Acute Liver Failure
Liver Failure
Methylprednisolone Hemisuccinate
Parvovirus
Antilymphocyte Serum
Hematologic Diseases
Tacrolimus
Graft vs Host Disease
Granulocyte Colony-Stimulating Factor
Cyclosporine
Allografts

ASJC Scopus subject areas

  • Hepatology

Cite this

Goss, J. A., Schiller, G. J., Martin, P., Seu, P., Stribling, R., Mcdiarmid, S. V., ... Busuttil, R. W. (1997). Aplastic anemia complicating orthotopic liver transplantation. Hepatology, 26(4), 865-869.

Aplastic anemia complicating orthotopic liver transplantation. / Goss, John A.; Schiller, Gary J.; Martin, Paul; Seu, Philip; Stribling, Rise; Mcdiarmid, Sue V.; Shackleton, Christopher R.; Markowitz, Jay S.; Nuesse, Barbara J.; Goldstein, Leonard I.; Busuttil, Ronald W.

In: Hepatology, Vol. 26, No. 4, 01.10.1997, p. 865-869.

Research output: Contribution to journalArticle

Goss, JA, Schiller, GJ, Martin, P, Seu, P, Stribling, R, Mcdiarmid, SV, Shackleton, CR, Markowitz, JS, Nuesse, BJ, Goldstein, LI & Busuttil, RW 1997, 'Aplastic anemia complicating orthotopic liver transplantation', Hepatology, vol. 26, no. 4, pp. 865-869.
Goss JA, Schiller GJ, Martin P, Seu P, Stribling R, Mcdiarmid SV et al. Aplastic anemia complicating orthotopic liver transplantation. Hepatology. 1997 Oct 1;26(4):865-869.
Goss, John A. ; Schiller, Gary J. ; Martin, Paul ; Seu, Philip ; Stribling, Rise ; Mcdiarmid, Sue V. ; Shackleton, Christopher R. ; Markowitz, Jay S. ; Nuesse, Barbara J. ; Goldstein, Leonard I. ; Busuttil, Ronald W. / Aplastic anemia complicating orthotopic liver transplantation. In: Hepatology. 1997 ; Vol. 26, No. 4. pp. 865-869.
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abstract = "The clinical characteristics and outcome of posttransplantation aplastic anemia (AA) were determined in 12 of 1,736 patients (0.007{\%}) undergoing orthotopic liver transplantation (OLT) that were afflicted with AA. None of the affected patients had a history of hematologic disease. Median patient age was 53 years (range, 2-61 years); 10 of the affected patients were men, and 2 were women. The etiologies of AA included non-A, non-B, non-C fulminant hepatic failure (FHF) (3 patients), graft-versus-host disease (4 patients), Parvovirus-induced (1 patient), and idiopathic (4 patients). The median duration between OLT and the onset of AA was 12 days (range, 11-14 days) in the 3 patients undergoing OLT for FHF; in contrast, AA developed in the other 9 patients at 37 days (range, 27-51 days) after OLT. Eleven patients were treated with reduction of their cyclosporine or tacrolimus dosage, granulocyte colony-stimulating factor, anti-thymocyte globulin, and Solumedrol. Two of the 3 patients developing AA following OLT for FHF achieved hematologic recovery 21 and 92 days after diagnosis. In contrast, all 9 non-FHF patients developing AA after OLT died, 5 due to infectious complications and 4 following intracranial bleeding. AA is an unusual complication of OLT. In the setting of FHF, it affects young males in the early posttransplantation period, and, when infectious complications can be avoided, remission and stable allograft function can be anticipated. However, in the non-FHF patient, AA occurs in older individuals later in the posttransplantation period and has a uniformly poor outcome.",
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AU - Shackleton, Christopher R.

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