title: Contribution of fibrinolytic tests to the differential diagnosis of veno-occlusive disease complicating pediatric hematopoietic stem cell transplantation.
abstract: BACKGROUND
  Veno-occlusive disease (VOD) is a major complication following hematopoietic stem cell transplantation (HSCT). Its diagnosis is based on clinical criteria, which have a limited sensitivity. Increased plasminogen activator inhibitor-1 (PAI-1) levels have been suggested as a marker of VOD. We aimed to prospectively evaluate how the fibrinolytic parameters behaved to discriminate VOD from other liver disorders occurring after HSCT in a pediatric population.
  
  
  METHODS
  A total of 195 HSCT were performed on 161 children and VOD complicated 11 cases (6.8%). Alanine aminotransferase, total bilirubin, PAI-1 antigen (PAI-1:Ag) and activity, t-PA antigen, D-dimer, prothrombin time, activated partial thromboplastin time, antithrombin, fibrinogen, and platelet counts were measured in 105 HSCT before and then weekly for 1 month after HSCT.
  
  
  RESULTS
  An early, significant increase in the fibrinolytic parameters was seen in patients who developed VOD, even before VOD was diagnosed clinically, by comparison with patients without complications or those with non-VOD liver disorders. The combined increase in bilirubin, D-dimer, and PAI-1:Ag levels beyond the normal range distinguished VOD cases from other liver complications with a high sensitivity and specificity.
  
  
  CONCLUSIONS
  Our study demonstrates that fibrinolytic tests can help diagnose VOD after HSCT in the pediatric population.
authors.affiliation: Second Chair of Internal Medicine, Department of Cardiologic, Thoracic and Vascular Sciences, University of Padova, Padova, Italy. mtsart@unipd.it
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Sartori
authors.forename: Simone
authors.initials: S
authors.lastname: Cesaro
authors.forename: Mattia
authors.initials: M
authors.lastname: Peruzzo
authors.forename: Chiara
authors.initials: C
authors.lastname: Messina
authors.forename: Graziella
authors.initials: G
authors.lastname: Saggiorato
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Calore
authors.forename: Marta
authors.initials: M
authors.lastname: Pillon
authors.forename: Stefania
authors.initials: S
authors.lastname: Varotto
authors.forename: Luca
authors.initials: L
authors.lastname: Spiezia
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Cella
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D005260:Female; D005342:Fibrinolysis; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006504:Hepatic Veno-Occlusive Disease / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D007223:Infant; D008297:Male; D011446:Prospective Studies; D012680:Sensitivity and Specificity