A REVIEW OF TISSUE-PLASMINOGEN ACTIVATOR IN THE TREATMENT OF VENOOCCLUSIVE LIVER-DISEASE AFTER BONE-MARROW TRANSPLANTATION

Veno-occlusive disease (VOD) of the liver is a potentially life-threat ening complication that usually occurs secondary to high dose-chemothe rapy with or without total body irradiation as preparative therapy for bone marrow transplantation. The key event in the development of VOD is damage to the vascular endothelium in the liver, which produces a h ypercoagulable state triggering the clotting cascade. Factor VIII and fibrinogen are deposited in the hepatic venules, leading to obliterati on of the venules. Tissue plasminogen activator (t-PA) converts fibrin -bound plasminogen to plasmin, thereby producing clot lysis. Review of the literature suggests that t-PA can be administered safely, with so me limitations, for the treatment of VOD.