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Article: Risk factors and mortality predictors of hepatic veno-occlusive disease after pediatric hematopoietic stem cell transplantation

TitleRisk factors and mortality predictors of hepatic veno-occlusive disease after pediatric hematopoietic stem cell transplantation
Authors
Issue Date2007
PublisherNature Publishing Group. The Journal's web site is located at http://www.nature.com/bmt
Citation
Bone Marrow Transplantation, 2007, v. 40 n. 10, p. 935-944 How to Cite?
AbstractA cohort of 138 children with 144 hematopoietic stem cell transplantation (HSCT) performed in 1997-2006 were analyzed to evaluate risk factors and mortality predictors of hepatic veno-occlusive disease (VOD). Nineteen patients (13.2%) developed VOD (nine boys, median age 3.5 years) at 1-21 days after HSCT (median 13 days). Age ≤2 years at transplant (odds ratio (OR) = 5.25, P = 0.011), BU-CY conditioning (OR = 5.16, P = 0.001), thalassemia major (OR = 3.97, P = 0.015), platelet engraftment beyond day ≤21 (OR = 8.67, P = 0.025) were univariate risk factors for VOD. The first two remained significant in multivariate regression. Seven patients (36.8%) with VOD died, at a median of 44 days post transplant (range, 30-421 days). The 5-year survival was 62%. All surviving patients had normal liver function on follow-up at 0.5-9 years. Patients with VOD had higher 100-day mortality (16.3 vs 9.6%, P = 0.024). Mortality predictors included donors other than autologous or matched sibling (hazard ratio (HR) = 23.6, P = 0.006), hepatic and cutaneous GVHD (HR = 8.15, P = 0.038), maximal weight gain >9% (HR = 6.81, P = 0.023), pleural effusion, intensive care unit admission, peak bilirubin >300 μmol l -1 (HR = 13.6, P = 0.016), day +21 bilirubin >200 μ mol l -1 (HR = 33.9, P = 0.001), and rise of bilirubin >15 μmol l -1 per day within the first week (HR = 19.8, P = 0.006). Mortality was substantially higher if >3 predictors were present (HR = 33.9, P = 0.001). Meticulous monitoring in high-risk patients and early treatment should be considered before VOD progresses beyond salvage.
Persistent Identifierhttp://hdl.handle.net/10722/79749
ISSN
2015 Impact Factor: 3.636
2015 SCImago Journal Rankings: 1.585
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorCheuk, DKLen_HK
dc.contributor.authorWang, Pen_HK
dc.contributor.authorLee, TLen_HK
dc.contributor.authorChiang, AKSen_HK
dc.contributor.authorHa, SYen_HK
dc.contributor.authorLau, YLen_HK
dc.contributor.authorChan, GCFen_HK
dc.date.accessioned2010-09-06T07:58:15Z-
dc.date.available2010-09-06T07:58:15Z-
dc.date.issued2007en_HK
dc.identifier.citationBone Marrow Transplantation, 2007, v. 40 n. 10, p. 935-944en_HK
dc.identifier.issn0268-3369en_HK
dc.identifier.urihttp://hdl.handle.net/10722/79749-
dc.description.abstractA cohort of 138 children with 144 hematopoietic stem cell transplantation (HSCT) performed in 1997-2006 were analyzed to evaluate risk factors and mortality predictors of hepatic veno-occlusive disease (VOD). Nineteen patients (13.2%) developed VOD (nine boys, median age 3.5 years) at 1-21 days after HSCT (median 13 days). Age ≤2 years at transplant (odds ratio (OR) = 5.25, P = 0.011), BU-CY conditioning (OR = 5.16, P = 0.001), thalassemia major (OR = 3.97, P = 0.015), platelet engraftment beyond day ≤21 (OR = 8.67, P = 0.025) were univariate risk factors for VOD. The first two remained significant in multivariate regression. Seven patients (36.8%) with VOD died, at a median of 44 days post transplant (range, 30-421 days). The 5-year survival was 62%. All surviving patients had normal liver function on follow-up at 0.5-9 years. Patients with VOD had higher 100-day mortality (16.3 vs 9.6%, P = 0.024). Mortality predictors included donors other than autologous or matched sibling (hazard ratio (HR) = 23.6, P = 0.006), hepatic and cutaneous GVHD (HR = 8.15, P = 0.038), maximal weight gain >9% (HR = 6.81, P = 0.023), pleural effusion, intensive care unit admission, peak bilirubin >300 μmol l -1 (HR = 13.6, P = 0.016), day +21 bilirubin >200 μ mol l -1 (HR = 33.9, P = 0.001), and rise of bilirubin >15 μmol l -1 per day within the first week (HR = 19.8, P = 0.006). Mortality was substantially higher if >3 predictors were present (HR = 33.9, P = 0.001). Meticulous monitoring in high-risk patients and early treatment should be considered before VOD progresses beyond salvage.en_HK
dc.languageengen_HK
dc.publisherNature Publishing Group. The Journal's web site is located at http://www.nature.com/bmten_HK
dc.relation.ispartofBone Marrow Transplantationen_HK
dc.titleRisk factors and mortality predictors of hepatic veno-occlusive disease after pediatric hematopoietic stem cell transplantationen_HK
dc.typeArticleen_HK
dc.identifier.openurlhttp://library.hku.hk:4550/resserv?sid=HKU:IR&issn=0268-3369&volume=40&spage=935&epage=944&date=2007&atitle=Risk+factors+and+mortality+predictors+of+hepatic+veno-occlusive+disease+after+pediatric+hematopoietic+stem+cell+transplantationen_HK
dc.identifier.emailChiang, AKS:chiangak@hkucc.hku.hken_HK
dc.identifier.emailLau, YL:lauylung@hkucc.hku.hken_HK
dc.identifier.emailChan, GCF:gcfchan@hkucc.hku.hken_HK
dc.identifier.authorityChiang, AKS=rp00403en_HK
dc.identifier.authorityLau, YL=rp00361en_HK
dc.identifier.authorityChan, GCF=rp00431en_HK
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.1038/sj.bmt.1705835en_HK
dc.identifier.pmid17768390-
dc.identifier.scopuseid_2-s2.0-35748979989en_HK
dc.identifier.hkuros138062en_HK
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-35748979989&selection=ref&src=s&origin=recordpageen_HK
dc.identifier.volume40en_HK
dc.identifier.issue10en_HK
dc.identifier.spage935en_HK
dc.identifier.epage944en_HK
dc.identifier.isiWOS:000250536200005-
dc.publisher.placeUnited Kingdomen_HK
dc.identifier.scopusauthoridCheuk, DKL=8705936100en_HK
dc.identifier.scopusauthoridWang, P=22954874800en_HK
dc.identifier.scopusauthoridLee, TL=8508917400en_HK
dc.identifier.scopusauthoridChiang, AKS=7101623534en_HK
dc.identifier.scopusauthoridHa, SY=7202501115en_HK
dc.identifier.scopusauthoridLau, YL=7201403380en_HK
dc.identifier.scopusauthoridChan, GCF=16160154400en_HK
dc.identifier.citeulike1617422-

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