[wang082]

My 4-year old daughter had matched sibling cord blood transplant ~5 months ago and she developed level II gut GVHD 2 month after transplant. In the past two months, she had several fungus & bacteria & unknown blood infections, as well as a recent respiratory failure which required ossilating ventilor for several days.

When she just recovered from the respriratory failure, her liver function suddenly deteriorated dramatically in the past two weeks: triglycerides (2730), GGT (5482), Bilirubin total (17.9), ALT/AST (173/228). Luckily, her pancreas seems doing OK so far.

She has been on TPN for > 5 months and other meds: CSA, steroid, caspofugin, voriconazole, ganciclorovir, acyclovir and many antibiotics for extended periods.

Ultrasound shows no evidence of hepatic veno-occlusive desease or biliary obstruction. It does suggest continued gallbladder sludge, but without cholecystitis.

The removal TPN (~ 1 week) does not yield noticable improvement. CSA was changed to MMF yesterday. It's prabobly too soon to see its impact. The low likelyhood of having liver GVHD does not warrant a liver biopsy at this point. I was told there is no safe and effective medicine available to lower down triglycerides level and help heal liver.

Does anyone have any previous experience with this? Any ideas are welcome and highly appreciated.