Evaluation of patients transplanted in the pediatric bone marrow unit between 2010 and 2021, wi̇th elevated liver enzyme in the first year

Objective: In our study, C.U.T.F. The aim was to retrospectively evaluate the results of patients transplanted between 2010 and 2021 in the pediatric bone marrow transplant unit, examine liver function tests within the first year, and investigate etiological causes. Material and Method: Liver enzyme values and other data of patients who underwent transplantation between 2010 and 2021 in the pediatric bone marrow unit of Cukurova University Faculty of Medicine were evaluated retrospectively within the first year. Data from a total of 298 patients were evaluated in the study. Preparation regimen according to diagnosis groups and transplant types; determined as myeloablative or reduced-intensity regimen. Ursodeoxycholic acid was used in hepatic SOS prophylaxis. Myeloid engraftment time was accepted as the first day when the absolute neutrophil count was > 500/mm³ for 3 consecutive days. Elevated AST, ALT, LDH or bilirubin for the first 15 days from the start of the preparation regimen was considered as drug toxicity. In cases with GVHD-type clinical symptoms and/or those that could be removed, it was considered acute by biopsy and chronic according to the biopsy result. Results: 63.4% of the patients were girls and 36.6% were boys. 9.7% of the patients were younger than 2 years old, 25.2% were between 2 and 5 years old, 36.9% were between 5 and 10 years old, and 28.2% were older than 10 years old. According to the admission diagnoses of the patients, the rate of those admitted due to malignancy was 35.9%, the rate of those admitted due to hematological diseases was 47%, and the rate of those admitted due to immunodeficiency was 13.8%. Early complications were observed in 61.1% of the patients, late complications were observed in 1%, and both early and late complications were observed in 20.6%. The rate of patients with early GVHD involvement was 25.8%. The most common involvements of GVHD were skin and intestine (31.6%) and skin only (22.5%), respectively. The most common complications were hemorrhagic cystitis with 16.6% and renal disease with 13.8%, respectively. complications and 10.4% were central nervous system complications. The rate of patients with abnormal laboratory parameters before hematopoietic stem cell transplantation was 82.2%. The rate of patients with anemia was 71.1%, the rate of patients with pancytopenia was 28.2%, the rate of patients with high AST values was 40.2%, the rate of patients with high ALT values was 41.9%, and the rate of patients with high lactate dehydrogenase values was 17.8%. determined. The etiologies that most frequently increased liver function tests after hematopoietic stem cell transplantation were culture growth with 73.5% and CMV infection with 48%. A single etiology was detected in 50.3% of the patients, two different etiologies in 28.5%, three different etiologies in 17.1% and four different etiologies in 4%. At the end of the treatment period, 51.9% of liver function tests did not improve and 43.9% of the patients died. While the one-year survival rate was determined as 70.5%, the five-year survival rate was 52% and the ten-year survival rate was 52%. It was determined that there was no significant difference in the survival of the patients according to their gender (p = 0.822). Among age groups, the average survival time of the 24-60 month age group was found to be significantly higher than the other groups (p = 0.018). It was determined that there was no statistically significant difference in mean survival times according to the year of transplantation (p=0.680). It was determined that survival did not change significantly depending on the type of transplantation (p = 0.127). However, the survival time of patients using peripheral stem cells as a bone marrow source was found to be statistically significantly lower (p=0.014). Additionally, it was observed that as the HLA compatibility level increased, survival times increased statistically significantly (p=0.001). It was observed that the average survival time was prolonged in patients with high post-transplant bilirubin levels, pre-transplant anemia and pancytopenia, and post-transplant LDH elevation (p=0.001, p=0.019, p=0.009 and p=0.007, respectively). Conclusion: As a result of our study, it was seen that the high liver function tests were a factor that negatively affected the success of transplantation. It is recommended to raise awareness about high liver function tests before and after transplantation and to take necessary precautions. Key Words: Hematopoietic Stem Cell Transplantation, Liver Enzymes, Pediatric