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The role of peritoneal drainage in veno-occlusive disease in pediatric patients post hematopoietic stem cell transplant

Bone Marrow Transplantation volume 53, pages 938–941 (2018)Cite this article

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Severe veno-occlusive disease (VOD), or sinusoidal obstruction syndrome (SOS), is a significant cause of post-HSCT morbidity and mortality. This complication typically develops predominantly in the first 21 days of HSCT, although pediatric onset may be later in 15–20% [1]. Severe VOD/SOS leads to multi-organ failure (MOF), in which mortality exceeds 80% [2, 3].

The incidence of SOS/VOD in children after HSCT varies widely in reports, ranging from 8 to 60% [1, 4, 5]. The diagnosis is typically made by clinical observations as outlined by the Baltimore or the modified Seattle criteria [6, 7]. The Baltimore criteria are based on the presence of hyperbilirubinemia (>2 mg/dL) and 2 of the following: weight gain >5% from baseline, hepatomegaly, or ascites. The modified Seattle criteria require any 2 of the following: hyperbilirubinemia (2 mg/dL), ascites and/or unexplained weight gain of >2% from baseline or hepatomegaly and right upper quadrant pain. Reversal of portal flow by ultrasound is commonly noted, although this is not pathognomonic nor included in the Baltimore or modified Seattle criteria.

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References

  1. Corbacioglu S, Cesaro S, Faraci M, Valteau-Couanet D. Gruhn Be, et al. Defibrotide for prophylaxis of hepatic veno-occlusive disease in paediatric haematopoietic stem cell transplantation: an open label, phase 3, randomized controlled trial. Lancet. 2012;379:1301–9.

    Article  PubMed  CAS  Google Scholar 

  2. Coppell JA, Richardson G, Soiffer R, Martin PL, Kernan NA, Chen A, et al. Hepatic veno-occlusive disease following stem cell transplantation: Incidence, clinical course, and outcome. Biol Blood Marrow Transplant. 2010;16:157–68.

    Article  PubMed  Google Scholar 

  3. Mohty M, Malard F, Abecassis M, Aerts E, Alaskar AS, Aljrf M, et al. Sinusoidal obstruction syndrome/veno-occlusive disease: current situation and perspectives- a position statement from the European Society for Blood and Marrow Transplantation (EBMT). Bone Marrow Transplant. 2015;6:781–9.

    Article  Google Scholar 

  4. Madenci AL, Stetson A, Weldon CB, Lehmann LE. Safety of peritoneal and pleural drain placement in pediatric stem cell transplant recipients with severe veno-occlusive disease. Pediatr Transplant. 2016;5:687–91.

    Article  CAS  Google Scholar 

  5. Coutsouvelis J, Avery S, Dooley M, Kirkpatrick C, Spencer A. Defibrotide for the management of sinusoidal obstruction syndrome in patients who undergo haematopoietic stem cell transplantation. Cancer Treat Rev. 2016;50:200–4.

    Article  PubMed  CAS  Google Scholar 

  6. Jones RJ, Lee KS, Beschorner WE, Vogel VG, Grochow LB, Braine HG, et al. Venoocclusive disease of the liver following bone marrow transplantation. Transplantation. 1987;44:778–83.

    Article  PubMed  CAS  Google Scholar 

  7. McDonald GB, Sharma P, Matthews DE, Shulman HM, Thomas ED. Veno-occlusive disease of the liver and multiorgan failure after bone marrow transplantation: diagnosis, incidence, and predisposing factors. Hepatology. 1984;4:116–22.

    Article  PubMed  CAS  Google Scholar 

  8. Skeens MA, McArthur J, Cheifetz IM, Duncan C, Randolph AG, Stanek J, and HSCT subgroup of the Pediatric Acute Lung Injury & Sepsis Investigators (PALISI). et al. High variability in the reported management of hepatic veno-occlusive disease in children after hematopoietic stem cell transplantation. Biol Blood Marrow Transplant. 2016;10:1823–8.

    Article  Google Scholar 

  9. Corbacioglu S, Greil J, Peters C, Wulffraat N, Laws HJ, Dilloo D, et al. Defibrotide in the treatment of children with veno-occlusive disease (VOD): a retrospective multicentre study demonstrates therapeutic efficacy upon early intervention. Bone Marrow Transplant. 2004;33:189–95.

    Article  PubMed  CAS  Google Scholar 

  10. Richardson PG, Smith AR, Triplett BM, Kernan NA, Grupp SA, Antin JH, and Defibrotide Study Group. et al. Defibrotide for patients with hepatic veno-occlusive disease/sinusoidal obstruction syndrome: interim results from a treatment IND study. Biol Blood Marrow Transplant. 2017;6:997–1004.

    Article  CAS  Google Scholar 

  11. Mahadeo KM, McArthur J, Adams RH, Radhi M, Angelo J, Jeyapalan A, et al. Consensus report by PALISI and PBMTC Joint Working Committees, Supportive care guidelines for management of VOD in children and adolescents: Part 2- Focus on ascites; fluids, electrolytes, renal and transfusion issues. Biol Blood Marrow Transplant. 2017;23:2023–2033.

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Acknowledgements

We thank Michael Loyer for data assistance, and Margaret Tartaglione for defibrotide study coordination.

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Authors and Affiliations

  1. Division of Oncology, The Children’s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, USA

    Hafsat Mashegu, Laura Smith, Yimei Li, Alix Seif, Stephan Grupp & Nancy Bunin

  2. Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine at University of Pennsylvania, Philadelphia, USA

    Yimei Li

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Correspondence to Nancy Bunin.

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SG has consulted for Jazz Pharmaceuticals. The remaining authors declare that they have no conflict of interest.

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Mashegu, H., Smith, L., Li, Y. et al. The role of peritoneal drainage in veno-occlusive disease in pediatric patients post hematopoietic stem cell transplant. Bone Marrow Transplant 53, 938–941 (2018). https://doi.org/10.1038/s41409-018-0113-9

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