Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Post-Transplant Complications

Veno-occlusive disease of the liver after allogeneic bone marrow transplantation for severe aplastic anemia

Abstract

There are few reports about the occurrence of hepatic VOD after BMT for severe aplastic anemia (SAA). We prospectively studied 17 patients with SAA after allogeneic BMT for the occurrence and severity of VOD. Plasma levels of protein C, protein S, antithrombin III, vWF, t-PA and PAI-1 were determined before preparative chemotherapy, on the day of marrow infusion, and on days 7, 14 and 21. VOD occurred in seven patients (41.2%) at a median of day 1 (range, day −2 to 15). Five had mild, and two moderate VOD. Platelet transfusion requirements were higher in the patients with VOD. The plasma levels of natural anticoagulants such as protein C, free protein S and antithrombin III decreased significantly on day 0 from the baseline levels. Plasma levels of t-PA, PAI-1 and vWF increased significantly in the early post-transplant period compared to the baseline levels. The mean plasma levels of t-PA on day 7 (P = 0.016) and PAI-1 on days 0 and 7 (P = 0.016, 0.032) were higher in the patients with VOD. In summary, we observed hypercoagulability and a high incidence of VOD after allogeneic BMT for SAA. Levels of t-PA and PAI-1 were significantly higher in the patients with VOD after BMT. Bone Marrow Transplantation (2000) 26, 657–662.

This is a preview of subscription content, access via your institution

Access options

Buy this article

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. Bearman SI . The syndrome of hepatic veno-occlusive disease after marrow transplantation Blood 1995 85: 3005–3020

    CAS  PubMed  Google Scholar 

  2. McDonald GB, Hinds MS, Fisher LD et al. Veno-occlusive disease of the liver and multiorgan failure after bone marrow transplantation: a cohort study of 355 patients Ann Intern Med 1993 118: 255–267

    CAS  PubMed  Google Scholar 

  3. Locasciulli A, Bacigalupo A, Alberti A et al. Predictability before transplant of hepatic complications following allogeneic bone marrow transplantation Transplantation 1989 48: 68–72

    CAS  PubMed  Google Scholar 

  4. Witherspoon RP, Storb R, Shulman H et al. Marrow transplantation in hepatitis-associated SAA Am J Hematol 1984 17: 269–278

    CAS  PubMed  Google Scholar 

  5. Zanis-Neto J, Ribeiro RC, Medeiros C et al. Bone marrow transplantation for patients with Fanconi anemia: a study of 24 cases from a single institute Bone Marrow Transplant 1995 15: 293–298

    CAS  PubMed  Google Scholar 

  6. DeLeve LD . Cellular target of cyclophosphamide toxicity in the murine liver: role of glutathione and site of metabolic activation Hepatology 1996 24: 830–837

    CAS  PubMed  Google Scholar 

  7. Goldberg JW, Lidsky MD . Cyclophosphamide-associated hepatotoxicity South Med J 1985 78: 222–223

    CAS  PubMed  Google Scholar 

  8. Clelland BD, Pokorny CS . Cyclophosphamide related hepatotoxicity Aust N Z J Med 1993 23: 408

    Google Scholar 

  9. Modzelewski JR, Daeschner C, Joshi VV et al. Veno-occlusive disease of the liver induced by low dose cyclophosphamide Mod Pathol 1994 7: 967–972

    PubMed  Google Scholar 

  10. Teicher BA, Crawford JM, Holden SA et al. Glutathione monoethyl ester can selectively protect liver from high dose BCNU or cyclophosphamide Cancer 1988 62: 1275–1281

    CAS  PubMed  Google Scholar 

  11. Shulman HM, Hinterberger W . Hepatic veno-occlusive disease – liver toxicity syndrome after bone marrow transplantation Bone Marrow Transplant 1992 10: 197–214

    CAS  PubMed  Google Scholar 

  12. Rozman C, Carreras E, Qian C et al. Risk factors for hepatic veno-occlusive disease following HLA-identical sibling bone marrow transplants for leukemia Bone Marrow Transplant 1996 17: 75–80

    CAS  PubMed  Google Scholar 

  13. Bunin N, Leahey A, Dunn S . Related donor liver transplant for veno-occlusive disease following T-depleted unrelated donor bone marrow transplantation Transplantation 1996 61: 664–666

    CAS  PubMed  Google Scholar 

  14. Rocha V, Devergie A, Socie G et al. Unusual complications after bone marrow transplantation for dyskeratosis congenita Br J Haematol 1998 103: 243–248

    CAS  PubMed  Google Scholar 

  15. Shulman HM, McDonald GB, Matthews D et al. An analysis of hepatic venocclusive disease and centrilobular hepatic degeneration following bone marrow transplantation Gastroenterology 1980 79: 1178–1191

    CAS  PubMed  Google Scholar 

  16. Slattery JT, Kalhorn TF, McDonald GB et al. Conditioning regimen-dependent disposition of cyclophosphamide and hydroxycyclophosphamide in human marrow transplantation patients J Clin Oncol 1996 14: 1484–1494

    CAS  PubMed  Google Scholar 

  17. Baglin TP . Veno-occlusive disease of the liver complicating bone marrow transplantation Bone Marrow Transplant 1994 13: 1–4

    CAS  PubMed  Google Scholar 

  18. Rio B, Andreu G, Nicod A et al. Thrombocytopenia in venocclusive disease after bone marrow transplantation or chemotherapy Blood 1986 67: 1773–1776

    CAS  PubMed  Google Scholar 

  19. Harper PL, Jarvis J, Jennings I et al. Changes in the natural anticoagulants following bone marrow transplantation Bone Marrow Transplant 1990 5: 39–42

    CAS  PubMed  Google Scholar 

  20. Gordon B, Haire W, Kessinger A et al. High frequency of antithrombin 3 and protein C deficiency following autologous bone marrow transplantation for lymphoma Bone Marrow Transplant 1991 8: 497–502

    CAS  PubMed  Google Scholar 

  21. Collins PW, Gutteridge CN, O'Driscoll A et al. von Willebrand factor as a marker of endothelial cell activation following BMT Bone Marrow Transplant 1992 10: 499–506

    CAS  PubMed  Google Scholar 

  22. Catani L, Gugliotta L, Mattioli Belmonte M et al. Hypercoagulability in patients undergoing autologous or allogeneic BMT for hematological malignancies Bone Marrow Transplant 1993 12: 253–259

    CAS  PubMed  Google Scholar 

  23. Salat C, Holler E, Reinhardt B et al. Parameters of the fibrinolytic system in patients undergoing BMT: elevation of PAI-1 in veno-occlusive disease Bone Marrow Transplant 1994 14: 747–750

    CAS  PubMed  Google Scholar 

  24. Lee JH, Lee KH, Kim S et al. Relevance of proteins C and S, antithrombin III, von Willebrand factor, and factor VIII for the development of hepatic veno-occlusive disease in patients undergoing allogeneic bone marrow transplantation: a prospective study Bone Marrow Transplant 1998 22: 883–888

    CAS  PubMed  Google Scholar 

  25. Salat C, Holler E, Kolb HJ et al. Plasminogen activator inhibitor-1 confirms the diagnosis of hepatic veno-occlusive disease in patients with hyperbilirubinemia after bone marrow transplantation Blood 1997 89: 2184–2188

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lee, JH., Lee, KH., Choi, SJ. et al. Veno-occlusive disease of the liver after allogeneic bone marrow transplantation for severe aplastic anemia. Bone Marrow Transplant 26, 657–662 (2000). https://doi.org/10.1038/sj.bmt.1702583

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.bmt.1702583

Keywords

This article is cited by

Search

Quick links