INCIDENCE AND OUTCOME OF HEPATIC VENOOCCLUSIVE DISEASE AFTER BLOOD ORMARROW TRANSPLANTATION - A PROSPECTIVE COHORT STUDY OF THE EUROPEAN GROUP FOR BLOOD AND MARROW TRANSPLANTATION

To determine the incidence and outcome of hepatic venoocclusive diseas e (VOD) after blood or marrow transplantation (BMT), we prospectively evaluated all consecutive patients receiving a BMT during a 6-month pe riod in participating EBMT centers. All of them were evaluated for occ urrence of VOD according to previously defined clinical criteria. The clinical course, outcome, value of prophylactic and therapeutic interv entions, and the influence of previously described risk factors were a nalyzed. During the study period, 1,652 BMT were performed in 73 cente rs. VOD was diagnosed in 87 patients (5.3%; 95% confidence interval [C I], 4.2% to 6.4%). Fifty-six of 631 allogeneic BMT (8.9%) and 31 of 1, 010 autologous BMT (3.1%) developed this complication (P < .0001). VOD was classified as mild in 7 (8%), moderate in 56 (64.4%), and severe in 24 (27.6%) cases. Sixteen patients died of VOD (corresponding to 1% of the whole series. 18.4% of VOD patients, and 66.7% of severe VOD). The use of unfractionated heparin did not significantly decrease the incidence of VOD. Independent variables associated with an increased r isk of VOD were allogeneic BMT (relative risk [RR], 2.8; P < .001), pr e-BMT elevation of serum aspartate aminotransferase (RR, 2.4; P = .001 ), high-dose cytoreductive therapy (RR, 2.3; P = .003), Karnofsky perf ormance score less than 90% (RR, 2.7; P = .006), and prior abdominal r adiation (RR, 2.9; P = .03). In conclusion, this prospective study sho ws that (1) the incidence of VOD is lower than that reported in smalle r studies from single centers, (2) about one fourth of cases of VOD pr ogress to severe disease, (3) main risk factors have a major impact on incidence of VOD, and (4) the use of prophylactic unfractionated hepa rin does not seem to reduce the incidence of VOD. (C) 1998 by The Amer ican Society of Hematology.