Pathogenesis of Hepatic Veno-Occlusive Disease in Patients Undergoing Hematopoietic Stem Cell Transplantation
| Autor: | B. Meng, Marianna Dávid, O. Tóth, J. Tábori, Ágnes Nagy, H. Losonczy |
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| Rok vydání: | 2006 |
| Předmět: |
Hepatitis
medicine.medical_specialty Hepatic veno-occlusive disease business.industry medicine.medical_treatment Hematopoietic stem cell transplantation Defibrotide medicine.disease Gastroenterology Thrombosis Transplantation Internal medicine Edema Ascites medicine medicine.symptom business medicine.drug |
| Zdroj: | 35th Hemophilia Symposium ISBN: 3540285431 |
| DOI: | 10.1007/3-540-28546-6_53 |
| Popis: | Hepatic veno-occlusive disease (VOD) is a common complication following hematopoietic stem cell transplantation (HSCT), it is reported to occur in 5–70% of patients undergoing HSCT. The different incidence of VOD between series may be related to the number of patients included, the different selection criteria, the difference in the definition of VOD and the variable incidence of risk factors [1–3]. Clinically VOD is characterized by painful hepatomegaly, jaundice and fluid retention which is usually ascites. The development of hepatic VOD is the consequence of the injury of hepatocytes surrounding the central veins in zone 3 of the liver acinus. Endothelial damage, subendothelial edema, activation of the blood coagulation system and fibrogenesis, and finally occlusion of the hepatic venules and hepatocyte necrosis develops. As many as half of the patients with VOD die, usually of multi-organ failure [4]. Risk factors for VOD include: virus hepatitis in the disease history, elevated liver function tests at the time of high-dose chemotherapy and HSCT, high dose chemoor radiotherapy (especially abdominal irradiation), unrelated or mismatched stem cell transplantation, administration of norethisteron, vancomycin, acyclovir or amphotericin B. Different prophylactic strategies have been explored to prevent the injury and the subsequent thrombosis of the hepatic venules. They include the administration of prostaglandin E1, pentoxyphyllin, ursodeoxycholic acid, unfractionated and low molecular weight heparins and defibrotide. The results of the clinical trials have been variable therefore the strategy for VOD prophylaxis remains controversial [5–12]. Research in VOD pathogenesis has concentrated in four different areas, like the determination of the degree of glutathione depletion, the importance of inflammatory mediators in the process, the activation of fibrogenesis and of blood coagulation system [13]. |
| Databáze: | OpenAIRE |
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