Veno-occlusive disease of the liver after allogeneic bone marrow transplantation for severe aplastic anemia.
There are few reports about the occurrence of hepatic VOD after BMT for severe aplastic anemia (SAA). We prospectively studied 17 patients with SAA after allogeneic BMT for the occurrence and severity of VOD. Plasma levels of protein C, protein S, antithrombin III, vWF, t-PA and PAI-1 were determined before preparative chemotherapy, on the day of marrow infusion, and on days 7, 14 and 21. VOD occurred in seven patients (41.2%) at a median of day 1 (range, day -2 to 15). Five had mild, and two moderate VOD. Platelet transfusion requirements were higher in the patients with VOD. The plasma levels of natural anticoagulants such as protein C, free protein S and antithrombin III decreased significantly on day 0 from the baseline levels. Plasma levels of t-PA, PAI-1 and vWF increased significantly in the early post-transplant period compared to the baseline levels. The mean plasma levels of t-PA on day 7 (P = 0.016) and PAI-1 on days 0 and 7 (P = 0.016, 0.032) were higher in the patients with VOD. In summary, we observed hypercoagulability and a high incidence of VOD after allogeneic BMT for SAA. Levels of t-PA and PAI-1 were significantly higher in the patients with VOD after BMT.
Lee
J H
JH
Department of Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Lee
K H
KH
Choi
S J
SJ
Min
Y J
YJ
Kim
J G
JG
Kim
S
S
Lee
J S
JS
Kim
S H
SH
Park
C J
CJ
Chi
H S
HS
Kim
W K
WK
D000293:Adolescent; D000328:Adult; D000741:Anemia, Aplastic / Q000628:therapy*; D000961:Antilymphocyte Serum; D000990:Antithrombin III / Q000378:metabolism; D016026:Bone Marrow Transplantation / Q000009:adverse effects*; D003520:Cyclophosphamide; D005260:Female; D006487:Hemostasis; D006504:Hepatic Veno-Occlusive Disease / Q000097:blood / Q000139:chemically induced / Q000209:etiology*; D006801:Humans; D008297:Male; D017395:Plasminogen Activator Inhibitor 1 / Q000097:blood; D011446:Prospective Studies; D010959:Tissue Plasminogen Activator / Q000097:blood; D019172:Transplantation Conditioning / Q000009:adverse effects*; D014184:Transplantation, Homologous; D014841:von Willebrand Factor / Q000378:metabolism
D000961:Antilymphocyte Serum; D017395:Plasminogen Activator Inhibitor 1; D014841:von Willebrand Factor; D003520:Cyclophosphamide; D000990:Antithrombin III; D010959:Tissue Plasminogen Activator