[Veno-occlusive disease of the liver after bone marrow transplantation. Report of the symposium Autograft in France and the group of study of bone marrow transplantation. France Auto-Greffe et le Groupe d'Etude de la Greffe de Moelle osseuse].
Hepatic veno-occlusive disease is a frequent complication after high-dose chemo- or radiotherapy after bone marrow transplantation and is a major cause of mortality. During the 3 weeks following transplantation, acute major hepatic vascularization is observed together with portal hypertension and weight gain, ascitis and oedema of the lower limbs due to non-thrombotic obstruction of the centrilobular hepatic veins. This report summarizes the observations presented at a French symposium of France Autogreffe and Groupe d'Etude de la Greffe de Moelle osseuse. Different pathogenic processes are implicated including endothelial mechanisms due to toxic factor related to graft preparations and immunosuppressor treatments (methotrexate, cyclosporin), physical factors related to irradiation, immunological factors related to the expression of class II antigens on endothelial cells and viral factors, in particular cytomegalovirus infection. The incidence of veno-occlusive disease varies greatly from one series to another. Two French groups reported 5 and 3 cases among 1991 and 253 autologous grafts respectively (1.2 and 2.3%) while the Seattle group observed 53% among 355 consecutive grafts, although the same clinical criteria were used. Histological criteria include fibrosis around a non-thrombotic occlusion of the centrilobular veins, cytolysis and congestion of the sinuses. Other methods for diagnosis include transjugular biopsy, the suprahepatic pressure and imaging techniques. Prophylactic continuous infusion of low-dose heparin has been associated with a lower incidence. Trials using anti-tumour necrosis drugs and prostaglandin E1 have also been undertaken and show possible effects towards decreasing prevalence.(ABSTRACT TRUNCATED AT 250 WORDS)
Rio
B
B
Service d'Hématologie, Hôtel-Dieu, Paris.
Cahn
J Y
JY
Attal
M
M
Drouet
L
L
Scrobohaci
M L
ML
Degos
F
F
Degott
C
C
Bearman
S I
SI
Grañena
A
A
Blaise
D
D
D000527:Alprostadil / Q000627:therapeutic use; D016026:Bone Marrow Transplantation / Q000009:adverse effects*; D005602:France / Q000453:epidemiology; D006493:Heparin / Q000627:therapeutic use; D006504:Hepatic Veno-Occlusive Disease / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D006801:Humans; D015994:Incidence; D007938:Leukemia / Q000601:surgery; D011379:Prognosis; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D014182:Transplantation, Autologous
D006493:Heparin; D010959:Tissue Plasminogen Activator; D000527:Alprostadil
Maladie veino-occlusive du foie après greffe de moelle osseuse. Compte rendu du symposium de France Auto-Greffe et du Groupe d'étude de la Greffe de Moelle Osseuse.