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Blood, Vol. 92 No. 10 (November 15), 1998:
pp. 3599-3604
Incidence and Outcome of Hepatic Veno-Occlusive Disease
After Blood or Marrow Transplantation: A Prospective Cohort
Study of the European Group for Blood and Marrow Transplantation
Enric Carreras,
Hartmut Bertz,
William Arcese,
Jean-Paul Vernant,
José-Francisco Tomás,
Hans Hagglund,
Giuseppe Bandini,
Hèléne Esperou,
James Russell,
Javier de la Rubia,
Gabriele Di Girolamo,
Hilde Demuynck,
Olivier Hartmann,
Johannes Clausen,
Tapani Ruutu,
Veronique Leblond,
Arturo Iriondo,
Alberto Bosi,
Isaac Ben-Bassat,
Vladimir Koza,
Alois Gratwohl, and
Jane F. Apperley on
behalf of the European Group for Blood and Marrow Transplantation
Chronic Leukemia Working Party
From Hospital Clinic, IDIBAPS, Barcelona, Spain; University of
Freiburg, Freiburg, Germany; Universita degli Studi La Sapienza, Rome,
Italy; Hôpital Henri Mondor, Creteil, France; Hospital de la
Princesa, Madrid, Spain; Huddinge Hospital, Huddinge, Sweden; Hospital
San Orsola, Bologna, Italy; Hôpital Saint Louis, Paris, France;
Foothills Hospital, Calgary, Alberta, Canada; Hospital La Fe, Valencia,
Spain; Ospedale Civile, Pescara, Italy; University Hospital, Leuven,
Belgium; Institut Gustave Roussy, Villejuif, France;
Universitätskrankenhaus Eppendorf, Hamburg, Germany; Helsinki
University Central Hospital, Helsinki, Finland; Hôpital
Pitié Salpétrière, Paris, France; Hospital
Marqués de Valdecilla, Santander, Spain; Ospedale di Careggi,
Firenze, Italy; Sheba Medical Center, Tel-Hashomer, Israel; Charles
University Hospital, Pilsen, Czech Republic; Kantonsspital, Basel,
Switzerland; and Hammersmith Hospital, London, UK.
To determine the incidence and outcome of hepatic veno-occlusive
disease (VOD) after blood or marrow transplantation (BMT), we
prospectively evaluated all consecutive patients receiving a BMT during
a 6-month period in participating EBMT centers. All of them were
evaluated for occurrence of VOD according to previously defined
clinical criteria. The clinical course, outcome, value of prophylactic
and therapeutic interventions, and the influence of previously
described risk factors were analyzed. During the study period, 1,652 BMT were performed in 73 centers. VOD was diagnosed in 87 patients
(5.3%; 95% confidence interval [CI], 4.2% to 6.4%).
Fifty-six of 631 allogeneic BMT (8.9%) and 31 of 1,010 autologous BMT
(3.1%) developed this complication (P < .0001). VOD was
classified as mild in 7 (8%), moderate in 56 (64.4%), and severe in
24 (27.6%) cases. Sixteen patients died of VOD (corresponding to 1%
of the whole series, 18.4% of VOD patients, and 66.7% of severe VOD).
The use of unfractionated heparin did not significantly decrease the
incidence of VOD. Independent variables associated with an increased
risk of VOD were allogeneic BMT (relative risk [RR], 2.8; P < .001), pre-BMT elevation of serum aspartate aminotransferase (RR,
2.4; P = .001), high-dose cytoreductive therapy (RR, 2.3; P = .003), Karnofsky performance score less than 90% (RR,
2.7; P = .006), and prior abdominal radiation (RR, 2.9;
P = .03). In conclusion, this prospective study shows that
(1) the incidence of VOD is lower than that reported in smaller studies
from single centers, (2) about one fourth of cases of VOD progress to
severe disease, (3) main risk factors have a major impact on incidence of VOD, and (4) the use of prophylactic unfractionated heparin does not
seem to reduce the incidence of VOD.
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