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Plasminogen activator inhibitor-1 confirms the diagnosis of hepatic
veno-occlusive disease in patients with hyperbilirubinemia after bone
marrow transplantation
C Salat, E Holler, HJ Kolb, B Reinhardt, R Pihusch, W Wilmanns and E Hiller
Medical Klinik III Klinikum Grosshadern der Ludwig-Maximilians- Universitat
Munchen, Germany.
Hepatic veno-occlusive disease (VOD) is a frequent and severe complication
after bone marrow transplantation (BMT). We previously have described
plasminogen activator inhibitor-1 (PAI-1) as a possible marker of VOD. To
confirm the significance of this finding, we now determined PAI-1 levels in
31 of 186 consecutive patients undergoing BMT who developed
hyperbilirubinemia greater than 3 mg/dL for various reasons. Diagnoses were
made by clinical criteria and confirmed by biopsy in 23 of 31 patients.
They included VOD (n = 7), acute graft- versus-host disease (GVHD) of the
liver (n = 7), and other hepatic injury (n = 17). PAI-1 (mean +/- SD) was
significantly (P < .001) elevated in patients with VOD (321.6 +/- 161.2
ng/mL) as compared with patients with GVHD (22.8 +/- 8.4 ng/mL) or other
hepatic damage (32.8 +/- 30.8 ng/mL) at the timepoint of bilirubin
increase. At the peak bilirubin concentration, the corresponding PAI-1
levels were 426.1 +/- 230.0 ng/mL in patients with VOD, 41.0 +/- 20.6 ng/
mL in patients with GVHD, and 44.6 +/- 32.9 ng/mL in patients with other
hepatic injury (P < .001 VOD v GVHD/other hepatic injury). Our results
underline the relevance of PAI-1 in the differential diagnosis of
hyperbilirubinemia after BMT and its significance as a sensitive and
specific marker of severe VOD.
Volume 89,
Issue 6,
pp. 2184-2188,
03/15/1997
Copyright © 1997 by The American Society of Hematology
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