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.
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.
Litzow
Mark R
MR
Division of Hematology and Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, MN 55905, USA. litzow.mark@mayo.edu
Repoussis
Panagiotis D
PD
Schroeder
Georgene
G
Schembri-Wismayer
David
D
Batts
Kenneth P
KP
Anderson
Peter M
PM
Arndt
Carola A S
CA
Chen
Michael G
MG
Gastineau
Dennis A
DA
Gertz
Morie A
MA
Inwards
David J
DJ
Lacy
Martha Q
MQ
Tefferi
Ayalew
A
Noël
Pierre
P
Solberg
Lawrence A
LA
Letendre
Louis
L
Hoagland
H Clark
HC
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
D014508:Urea; D010959:Tissue Plasminogen Activator; D001663:Bilirubin