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

S. Hasegawa, K. Horibe, T. Kawabe, K. Kato, S. Kojima, T. Matsuyama, N. Hirabayashi

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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 (≤ 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 (≤ 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.

Original languageEnglish
Pages (from-to)1191-1197
Number of pages7
JournalBone Marrow Transplantation
Volume22
Issue number12
DOIs
Publication statusPublished - Jan 1 1998
Externally publishedYes

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All Science Journal Classification (ASJC) codes

  • Hematology
  • Transplantation

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