ASSOCIATION OF PULMONARY-FUNCTION TESTING ABNORMALITIES AND SEVERE VENOOCCLUSIVE DISEASE OF THE LIVER AFTER MARROW TRANSPLANTATION

We investigated an association between pulmonary function testing (PFT ) before bone marrow transplantation and the development of severe ven o-occlusive disease (VOD) of the liver. We previously noted that reduc tions in diffusing capacity of the lung for carbon monoxide (corrected for hemoglobin) (DLCOc) were associated with mortality after transpla ntation, but this was not caused by respiratory failure. We performed a case-series review of prospectively collected data from 307 marrow r ecipients who underwent PFT within 2 weeks of transplantation. Of thes e, 170 (56%) developed VOD; 39 (13%) mild, 81 (26%) moderate, and 50 ( 16%) severe or fatal. Both total lung capacity (TLC) and DLCOc were as sociated with severe VOD in univariate analysis (P = 0.006 for each). However, DLCOc entered logistic regression models that contained varia bles for all known risk factors for severe VOD, while TLC did not cont ribute additional predictive information. The odds ratio (OR) associat ed with a DLCOc below the lower limits of normal (70% of predicted) wa s 2.4 (95% CI, 1.0 to 5.4; P = 0.04). We conclude that reduced diffusi on capacity of the lung measured before marrow transplantation is an i ndependent risk for severe hepatic VOD. We speculate that the decrease d DLCOc indicates pre-existing systemic endothelial cell damage and a susceptibility to severe hepatic injury from chemotherapy.