title: Veno-occlusive disease of the liver after blood and marrow transplantation: analysis of pre- and post-transplant risk factors associated with severity and results of therapy with tissue plasminogen activator.
abstract: We reviewed our blood and marrow transplantation (BMT) database from April 1982 to July 1996 and identified 111 of 474 patients with serum bilirubin concentration (SBR) > or = 34 micromol/l for two consecutive days within the first 20 days after related allogeneic or autologous BMT. Of the 111, 73 fulfilled the Seattle criteria for veno-occlusive disease of the liver (VOD) and had no other obvious cause for liver dysfunction. The patients were 16-60 years old (median, 39 years), and 41 were male (56%). Fourteen patients (19%) had autologous BMT, and 59 (81%) had allogeneic BMT. Twenty-eight (38%), 12 (16%), and 33 (45%) patients had severe, moderate, and mild VOD, respectively, by Seattle criteria. None of 23 patients with maximum (max) SBR > or = 257 micromol/l survived, all patients with max SBR < or = 128 micromol/l survived, and 7 of 15 patients (47%) with max SBR 128-257 micromol/l survived. The only pre-transplantation risk factor predictive of severe VOD was advanced disease state (P = 0.035), and the only transplant factors that predicted severe VOD were max SBR (P = 0.01) and maximum blood urea level (P = 0.03). Ten patients (all with creatinine levels > or = 150 micromol/l) were treated with tissue plasminogen activator; only two had a significant response and only one survived beyond day 120.
authors.affiliation: Division of Hematology and Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, MN 55905, USA. litzow.mark@mayo.edu
authors.forename: Mark R
authors.initials: MR
authors.lastname: Litzow
authors.forename: Panagiotis D
authors.initials: PD
authors.lastname: Repoussis
authors.forename: Georgene
authors.initials: G
authors.lastname: Schroeder
authors.forename: David
authors.initials: D
authors.lastname: Schembri-Wismayer
authors.forename: Kenneth P
authors.initials: KP
authors.lastname: Batts
authors.forename: Peter M
authors.initials: PM
authors.lastname: Anderson
authors.forename: Carola A S
authors.initials: CA
authors.lastname: Arndt
authors.forename: Michael G
authors.initials: MG
authors.lastname: Chen
authors.forename: Dennis A
authors.initials: DA
authors.lastname: Gastineau
authors.forename: Morie A
authors.initials: MA
authors.lastname: Gertz
authors.forename: David J
authors.initials: DJ
authors.lastname: Inwards
authors.forename: Martha Q
authors.initials: MQ
authors.lastname: Lacy
authors.forename: Ayalew
authors.initials: A
authors.lastname: Tefferi
authors.forename: Pierre
authors.initials: P
authors.lastname: Noël
authors.forename: Lawrence A
authors.initials: LA
authors.lastname: Solberg
authors.forename: Louis
authors.initials: L
authors.lastname: Letendre
authors.forename: H Clark
authors.initials: HC
authors.lastname: Hoagland
mesh_terms: D000293:Adolescent; D000328:Adult; D001663:Bilirubin / Q000097:blood; D016026:Bone Marrow Transplantation / Q000009:adverse effects*; D005260:Female; D006504:Hepatic Veno-Occlusive Disease / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality; D006801:Humans; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D036102:Peripheral Blood Stem Cell Transplantation / Q000009:adverse effects*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D014508:Urea / Q000097:blood
chemical_list: D014508:Urea; D010959:Tissue Plasminogen Activator; D001663:Bilirubin