Treatment of hepatic veno-occlusive disease after bone marrow transplantation with recombinant human tissue plasminogen activator (rh-tPA)

Ten children were treated with recombinant human tissue plasminogen activator (rh-tPA) for severe hepatic veno-occlusive disease (VOD) that developed after bone marrow transplantation. Treatment with rh-tPA was begun a median of 22 days (range; 13-127 days) after transplantation. Seven of 9 (78%) evaluable patients had complete resolution of their VOD. Four patients had hemorrhagic complications, and 2 of them died because of pulmonary hemorrhage and subdural hemorrhage, respectively. Although rh-tPA seems to be an effective therapy for established VOD, further studies will be necessary to determine its safety as well as the optimal dosing regimen.