[evansmom]

Hi Christine,

Glad to hear your husband's liver enzymes have settled down. My son had a BMT for aplastic anemia in 2008 and he had no GVH what so ever, which is the desired outcome for AA as there is no benefit to having GVH unlike MDS/leukemia. He did get odd little localized eczema patches that responded to hydrocortisone cream but no one thought it was GVH, including myself. Evan did have elevated alt/ast, both upwards around 250 frequently from around 6 months post transplant to 18 months post transplant. The BMT doc wanted to call this liver GVH but because the liver labs weren't climbing any further and his bili was normal, we did not treat it, rather just monitored it. I never believed it was liver GVH in view of the fact he never had the more common GVH afflictions of the skin, gut etc. The more I researched, the more I became convinced it was viral illnesses that were temporarily driving the alt/ast up. As you know, viral illnesses are very common and to be expected in the post transplant period. Looking back at his viral panels and the fact that he had some night sweats during that time period, it would appear as though he was fighting an EBV infection, probably mononucleosis.

All that to say that just because the liver numbers are up doesn't necessarily mean GVH. Steroids can temporarily settle anything down, regardless of what may be going on. Steroids also lower one's already low immune system, so it's a tough choice.

For us, I'm glad we waited and watched because things settled on their own.

Was it just your husband's alt/ast that were elevated or was it other numbers too like the bilirubin, amylase, GGT etc.? How high was the alt/ast? Is he already on antvirals (which tax the liver themselves)?