Chemotherapy, which has greatly improved the prognosis of children with malignant diseases, is potentially hepatotoxic. Furthermore, there is a risk for viral
hepatitis acquired by blood products. In this study we looked for hepatotoxicity and for chronic viral
hepatitis during and after
chemotherapy in 50 unselected children with malignant diseases. 29 children had been treated for
leukemia or
lymphoma, 19 for solid
tumors, 2 for
histiocytosis. All patients had been treated before 1991 and had received blood products not screened for
hepatitis C-antibodies. In 18 girls and 32 boys aged 12.3 years (range 6.7-24.5 years)
hepatitis B- and
hepatitis C-serology and liver function tests were measured during a routine check-up 3.6 years (range 0.5-11.8 years) after the last
chemotherapy. Liver function tests during
chemotherapy were reviewed retrospectively. During
chemotherapy 86% of children showed increased ALT and AST levels, 10% had levels above 500 U/l. At follow up 16 children (32%) had pathological liver function tests, especially slightly increased AST and ALT, 13 of these 16 patients had
chronic hepatitis C. In contrast only 2 of 34 patients with normal liver function tests had a viral
hepatitis (p = 0.001). Patients with elevation of AST and ALT above 100 U/l during
chemotherapy had significantly more often a viral
hepatitis than those with normal or slightly elevated
aminotransferases. Our study shows that hepatocellular damage is a frequent complication following
chemotherapy. However this progresses to chronic
liver disease very rarely unless the patient acquired a viral
hepatitis. The prevalence of
chronic hepatitis C was very high in our patients. As screening of blood products for
hepatitis C-antibodies is routinely performed since 1991 this problem is likely to have decreased.