PLASMA-LEVELS OF D-DIMER AND CIRCULATING ENDOTHELIAL ADHESION MOLECULES IN VENOOCCLUSIVE DISEASE OF THE LIVER FOLLOWING ALLOGENEIC BONE-MARROW TRANSPLANTATION

Veno-occlusive disease (VOD) of the liver is a frequent and life-threa tening complication of BMT. Recently. successful treatment by t-PA has been reported but has been compromised by fatal bleeding events. Ther efore, t-PA application should be restricted to patients with severe V OD. However, moderate and severe forms of VOD are difficult to disting uish in early stages. We analyzed plasma levels of cross-linked fibrin degradation products (D-dimer) and soluble endothelial adhesion molec ules such as sE-selectin, sVCAM-1 and sICAM-1 in 10 consecutive patien ts undergoing allogeneic BMT to evaluate their use in identifying seve re forms of VOD. During the observation period, 4 episodes of VOD occu rred, 2 of which were fatal due to early onset of multiorgan failure. Concentrations of D-dimer generally increased after transplantation. H owever, there was an additional significant increase in D-dimer levels during severe VOD. Thus, D-dimer levels above 1000 mu g/l were only f ound in 2 cases with severe VOD and fatal outcome. When compared with bilirubin concentrations substantial increases of D-dimers appeared ea rlier during the course of severe VOD. In contrast, VOD episodes were not accompanied by significant increases in sE-selectin, sVCAM-1 and s ICAM-1 levels. It is concluded that measurement of D-dimer concentrati ons may aid accuracy to the early diagnosis of severe VOD.