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Management of childhood aplastic anemia following liver transplantation for nonviral hepatitis: A French survey
Author(s) -
Delehaye Fanny,
Habes Dalila,
Dourthe MarieEmilie,
Bertrand Yves,
Michel Gerard,
Gaudichon Jérémie,
Debray Dominique,
Nelken Brigitte,
Pasquet Marlène,
Blanche Stéphane,
Leblanc Thierry
Publication year - 2020
Publication title -
pediatric blood and cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.116
H-Index - 105
eISSN - 1545-5017
pISSN - 1545-5009
DOI - 10.1002/pbc.28177
Subject(s) - medicine , aplastic anemia , liver transplantation , hepatitis , hepatitis c , pediatrics , gastroenterology , transplantation , hepatitis b , surgery , bone marrow
Background Hepatitis‐associated aplastic anemia (AA) is a rare syndrome combining acute hepatitis of variable severity and AA. Hepatitis may be severe enough to require urgent liver transplantation (LT). Herein, we describe clinical presentation and management of a cohort of pediatric patients diagnosed with AA after undergoing LT for nonviral hepatitis. Methods To describe this rare clinical situation, we performed a national survey and identified nine children treated for AA following LT during the last 10 years in France. Results All patients were treated first for hepatic failure with urgent LT. AA was diagnosed with a median delay of 34 days [21‐200] from the diagnosis of hepatitis. Seven children were treated with antithymocyte globulin/cyclosporine, one with CSA alone and one received bone marrow transplantation. At the last visit (median follow‐up: 4 years), outcomes were excellent: all patients were alive and in hematological remission (complete remission: 7; partial remission: 2). Immunosuppressive therapy was pursued in all patients due to the liver transplant. No unusual toxicities were reported. Conclusion AA after LT is considered a therapeutic challenge. Nevertheless, hematological outcome is good using a standard immunosuppressive approach.