Child ; Hepatic Veno-Occlusive Disease/etiology* ; Humans

Adolescent ; Adult ; Child ; Child, Preschool ; Female ; Hematopoietic Stem Cell Transplantation ; adverse effects ; Hepatic Veno-Occlusive Disease ; etiology ; Humans ; Male ; Middle Aged ; Young Adult

Studies investigating the effect of prophylactic drugs on hepatic veno-occlusive disease (VOD) development are rare in children that have undergone allogeneic hematopoietic stem cell transplantation (HSCT). This study examined risk factors for VOD, the effect of prophylactic low-dose heparin or lipo-prostaglandin E1 (lipo-PGE1) and the survival rate at day +100 in children undergoing allogeneic HSCT. Eighty five children underwent HSCT between June 1997 and September 2004. Patients were diagnosed and classified as having mild, moderate or severe VOD according to Seattle clinical criteria. Among 85 patients, 25 (29%) developed VOD. VOD occurred more frequently in patients receiving busulfan-based conditioning (24/65, 37%) than in those receiving TBI-based (1/10, 10%) or other (0/10, 0%) regimens (p<0.05). The incidence of VOD was lower in patients with non-malignant disease compared to those with malignant disease (p<0.05). Survival at day +100 for non-VOD patients was better than that for VOD patients (92% vs. 76%, p<0.05). No patients receiving prophylactic heparin or lipo-PGE1 were found to develop severe VOD, whereas 5 of 35 patients not receiving such prophylaxis developed severe VOD. Given severe VOD is associated with a high mortality rate, this study indicates that prophylactic heparin or lipo-PGE1 may decrease mortality in children undergoing HSCT.
Risk Factors ; Male ; Infant ; Humans ; Hepatic Veno-Occlusive Disease/etiology/mortality/*prevention & control ; Heparin/*therapeutic use ; Hematopoietic Stem Cell Transplantation/*adverse effects ; Female ; Child, Preschool ; Child ; Alprostadil/*therapeutic use ; Adult ; Adolescent

To analyze the impact of hepatitis B virus (HBV) infection on liver function of patients after hematopoietic stem cell transplantation (HSCT), the transplantation outcome of 48 patients infected with HBV prior to transplantation among 185 patients received HSCT was investigated retrospectively. The results showed that during a follow-up for 6 months after HSCT, the alanine aminotransferase (ALT) peak average values of the patients with HBsAg(+), HBsAb(+) and control groups were (281.6 ± 414.6), (95.4 ± 79.9) and (65.1 ± 44.2) U/L, respectively. The incidences of abnormal liver function of the patients with HBsAg(+), HBsAb(+) and control groups were 61.54%, 40.00% and 30.23% respectively. There were no significant differences between any two groups (P > 0.05). The lethality of those patients at late period after transplantation was not related to HBV infection. The hepatocirrhosis and hepatocarcinoma caused by HBV infection have not become major problems in long-term survivors. It is concluded that in HBsAg(+) patients received HSCT, the damage of liver function is more severe than control group, possibly increasing the development of abnormal liver function. The measures against the liver function damage should be taken. The prophylactic administration of ganciclovir for virus may be effective to prevent the activation of HBV.
Adolescent ; Adult ; Child ; Female ; Hematopoietic Stem Cell Transplantation ; adverse effects ; Hepatic Veno-Occlusive Disease ; etiology ; prevention & control ; Hepatitis B ; physiopathology ; Hepatitis B virus ; Humans ; Liver ; physiopathology ; virology ; Liver Function Tests ; Male ; Middle Aged ; Retrospective Studies ; Young Adult

Adolescent ; Adult ; Drugs, Chinese Herbal ; adverse effects ; Female ; Hepatic Veins ; diagnostic imaging ; pathology ; Hepatic Veno-Occlusive Disease ; diagnosis ; etiology ; pathology ; Humans ; Image Processing, Computer-Assisted ; methods ; Liver ; diagnostic imaging ; pathology ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Portal Vein ; diagnostic imaging ; pathology ; Retrospective Studies ; Tomography, X-Ray Computed ; methods ; Young Adult

Adolescent ; Adult ; Alprostadil ; pharmacology ; Anticoagulants ; pharmacology ; Child ; Child, Preschool ; Dextrans ; pharmacology ; Female ; Fibrinolytic Agents ; pharmacology ; Hematopoietic Stem Cell Transplantation ; adverse effects ; Heparin ; pharmacology ; Hepatic Veno-Occlusive Disease ; etiology ; prevention & control ; therapy ; Humans ; Infant ; Male ; Middle Aged ; Platelet Aggregation Inhibitors ; pharmacology ; Treatment Outcome

Veno-occlusive disease (VOD) of the liver is a clinical syndrome characterized by hyperbilirubinemia, painful hepatomegaly, and fluid retention. In the bone marrow transplantation (BMT) setting, VOD is caused by dose-intensive chemotherapy and/or radiotherapy used to prepare patients for transplant. VOD occurs in up to 50% of the patients who undergo BMT and is usually associated with a high mortality rate. Until recently, there was no proven effective medical therapy for this condition once it was clinically apparent. We report here on the frequency and treatment result of VOD with rt-PA in our allogeneic BMT patients. Eight patients (median age 28.5 years) underwent allogeneic BMT from December, 1993 to June, 1995 in Asan Medical Center. Six leukemia patients were prepared for BMT with busulfan and cyclophosphmide, while two aplastic anemia patients received cyclophosphamide and antithymocyte globulin. VOD was defined as having two of the following features before day 20 posttransplant: jaundice (bilirubin > or = 2 mg/dL), tender hepatomegaly and/or right upper quadrant pain, ascites and/or unexplained weight gain (> 2% from baseline). All patients who were diagnosed with VOD received rt-PA (10-20 mg/day) and heparin (10,000 U/day). Three (37.5%) of the eight patients developed VOD that occurred between 6 and 10 days posttransplant. All three patients developed jaundice, weight gain, and tender hepatomegaly. Ascites and renal insufficiency occurred in two patients and pleural effusion in one patient. rt-PA and heparin were begun 6 to 26 days posttransplant and rt-PA was administered for 7 to 14 days. All three patients responded to the therapy; bilirubin levels began to decrease at 4 to 13 days from the start of therapy. They are all alive at day 111, 316, and 548 days posttransplant. None of the patients had significant hemorrhagic complications after rt-PA treatment. Prolonged administration of rt-PA was feasible without bleeding episode and it seems that rt-PA may alter the natural course of VOD.
Adolescent ; Adult ; Bone Marrow Transplantation/*adverse effects ; Drug Therapy, Combination ; Female ; Heparin/therapeutic use ; Hepatic Veno-Occlusive Disease/*drug therapy/etiology/physiopathology/prevention & control ; Human ; Immunosuppressive Agents/*adverse effects ; Male ; Preoperative Care/adverse effects ; Radiotherapy/*adverse effects ; Risk Factors ; Tissue Plasminogen Activator/*therapeutic use ; Treatment Outcome

OBJECTIVETo investigate the effect of compound Danshen injection combined with prostaglandin E1 low molecular weight heparin calcium to dextran-40 preventing hepatic veno-occlusive disease (HVOD) after hematopoietic stem cell transplantation (HSCT).

METHODSA total of 520 patients who received HSCT in the authors' hospital from May 1998 and December 2009 were subjected, among whom 231 patients received autologous peripheral blood stem cell transplantation, 125 received HLA-identical sibling HSCT, 49 received HLA-identical/mismatched unrelated HSCT and 115 received HLA-haplotype HSCT. All patients were treated by intravenous dripping of CSI 40-60 mL, dextran-40 250-500 mL, prostaglandin-E1 40-60 microg, and subcutaneous injection of low molecular weight heparin calcium 3 000-5 000 IU every day, the preventive effect on HVOD after HSCT was observed.

RESULTSHVOD occurred and caused death only in 1 case of the 520 patients observed, the incidence was 0.19%. Neither obvious adverse reaction nor coagulation disorder was found.

CONCLUSIONCompound Danshen Injection combined with prostaglandin E1, low molecular weight heparin calcium and dextran-40 is a safe and effective protocol for the prevention of HVOD after HSCT.

Adolescent ; Adult ; Alprostadil ; therapeutic use ; Child ; Child, Preschool ; Combined Modality Therapy ; Dextrans ; therapeutic use ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Hematopoietic Stem Cell Transplantation ; adverse effects ; Heparin, Low-Molecular-Weight ; therapeutic use ; Hepatic Veno-Occlusive Disease ; etiology ; prevention & control ; Humans ; Male ; Middle Aged ; Phenanthrolines ; therapeutic use