Aplastic anemia (AA) is a rare complication of
liver transplantation. The causes of AA have not yet been identified, and optimal
treatment for AA after
liver transplantation has not been firmly established. We experienced two cases of AA accompanied with
fulminant hepatitis among 157 pediatric recipients (1.3%) and among 17 recipients of Korean Network of Organ Sharing (KONOS) status 1 (11.8%). The
patients were a 16-year-old
girl and a 3-year-old boy
who had
jaundice and
lethargy due to non-A, non-B, non-C
fulminant hepatitis. The
girl underwent split
liver transplantation involving the
liver of a 24-year-old man, and the boy underwent an
emergency living donor liver transplantation with a
liver obtained from his 16-year-old cousin. Each
transplantation procedure was uneventful. However, both
patients were diagnosed with AA caused by
thrombocytopenia and
neutropenia at 140 and 26 days, respectively, after
liver transplantation. The
girl recovered completely after undergoing
bone marrow transplantation and was followed up for 70 months. However, the boy was conservatively treated because of the development of
hyperbilirubinemia and
pyrexia. He died of multi-organ failure 74 days after
liver transplantation. AA is not a rare complication of pediatric
liver transplantation for
fulminant hepatic failure. Therefore, AA must be suspected in pediatric cases of
cytopenia even after
liver transplantation. Our findings indicate
bone marrow transplantation is the
treatment of choice for AA even in cases where AA develops after
liver transplantation.