Veno-occlusive disease of the liver after allogeneic bone marrow transplantation in children with hematologic malignancies: incidence, onset time and risk factors

Abstract

One hundred and forty children with hematologic malignancies undergoing allogeneic BMT were reviewed in order to clarify the incidence, onset time, and risk factors for veno-occlusive disease (VOD) of the liver. Thirty-eight patients (27.1%) developed VOD diagnosed according to the Seattle clinical criteria. Seventeen patients developed VOD within 20 days of transplantation (early-onset) and in 21 patients developed after day 20 (late-onset) including eight patients with histological confirmation. Late-onset VOD occurred from day 21 to day 508 (median day 39). Moderate or severe VOD developed in 11 early-onset and 13 late-onset patients. Death occurred in eight early-onset and 10 late-onset patients. Serum albumin and cholinesterase levels prior to the start of pretransplant conditioning were significantly lower in early-onset VOD than in late-onset VOD. Multivariate analysis showed that low serum albumin levels (< or =3.7 g/dl) prior to the start of pretransplant conditioning was most strongly associated with the development of VOD. Donor mismatch (other than HLA-matched relatives), use of minocycline, and a long interval (> or =13 months) between diagnosis and BMT were also significantly associated with the development of VOD. In contrast, use of fosfomycin was associated with a decreased risk. Our data suggest that hepatic function reserve is important in the development and onset time of VOD. Veno-occlusive disease of the liver is a complication which may occur a long time after transplantation.

Predictive markers for hepatic veno-occlusive disease after hematopoietic stem cell transplantation in adults: a prospective single center study

“…It has been reported that poor hepatic function reserve may be a risk factor for hepatic VOD. 20,21 Our results might be relevant to this hypothesis, because fibrous change can result in poor functional reserve of the liver. On day 0, levels of t-PA were significantly higher in patients with VOD than without VOD in this study.…”

Gemtuzumab ozogamicin (Mylotarg) monotherapy for relapsed AML after hematopoietic stem cell transplant: efficacy and incidence of hepatic veno-occlusive disease

“…This patient may have been at higher risk than others in the series because she had had two prior stem cell transplants and had abnormal liver studies pre-therapy, both of which have been described as risk factors for VOD in the transplant setting. 8,10,22 The other seven patients tolerated GO therapy well without significant hepatotoxicity or VOD.…”

Risk factors and mortality predictors of hepatic veno-occlusive disease after pediatric hematopoietic stem cell transplantation

“…1,2 The cause of hepatic VOD is not entirely clear but a number of risk factors have been reported. [3][4][5][6] While many cases of mild VOD resolve spontaneously without complications, moderate-to-severe VOD may result in significant morbidity or even mortality. The management of VOD is mainly supportive, including fluid restriction and diuretics to ameliorate fluid retention and cardio-respiratory support if necessary.…”