A successful liver transplantation for refractory hepatic veno-occlusive disease originating from cord blood transplantation.
An 11-month-old boy with acute lymphoblastic leukemia (ALL) underwent umbilical cord blood transplantation (CBT) from an unrelated donor after a first complete remission. Despite the prophylactic use of low molecular weight heparin, prostaglandin E1 and ursodeoxycholic acid, hepatic veno-occlusive disease (VOD) occurred on the 29th day after CBT. Furthermore, neither defibrotide nor antithrombin-III improved the hepatic coma and coagulopathy due to the hepatic VOD. On the 42nd day after CBT, he underwent living related liver transplantation (LRLT) with a left lateral segment graft from his father. He received tacrolimus for the prevention of rejection and graft-vs.-host disease (GVHD) and also received aggressive antifungal and antiviral prophylaxis. Although he showed signs of acute rejection on postoperative days 5 and 10, the postoperative course was uneventful in general. At present, 17 months after LRLT, the patient shows stable liver function and no signs of either GVHD or a relapse of ALL. In conclusion, LRLT can be seen as a feasible option for the treatment of a hepatic VOD after CBT, though aggressive prophylaxis for infection and the anticipation of acute rejection are of importance.
Kim
Il-Deok
ID
Department of Transplantation and Immunology Kyoto University Hospital, Japan.
Egawa
Hiroto
H
Marui
Yuhji
Y
Kaihara
Satoshi
S
Haga
Hironori
H
Lin
Ying-Wei
YW
Kudoh
Kazuko
K
Kiuchi
Tetsuya
T
Uemoto
Shinji
S
Tanaka
Koichi
K
D036101:Cord Blood Stem Cell Transplantation / Q000009:adverse effects*; D006504:Hepatic Veno-Occlusive Disease / Q000209:etiology* / Q000601:surgery*; D006801:Humans; D007223:Infant; D008099:Liver / Q000473:pathology; D016031:Liver Transplantation; D008297:Male; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications* / Q000628:therapy