VENOOCCLUSIVE DISEASE OF THE LIVER AND MULTIORGAN FAILURE AFTER BONE-MARROW TRANSPLANTATION - A COHORT STUDY OF 355 PATIENTS
VENOOCCLUSIVE DISEASE OF THE LIVER AND MULTIORGAN FAILURE AFTER BONE-MARROW TRANSPLANTATION - A COHORT STUDY OF 355 PATIENTS
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DOI：
10.7326/0003-4819-118-4-199302150-00003
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发表时间：
1993-02-15
影响因子：
39.2
通讯作者：
CLIFT, RA
中科院分区：
文献类型：
--
作者：
MCDONALD, GB;HINDS, MS;CLIFT, RA
目的：确定骨髓移植后肝静脉闭塞性疾病（VOD）的发病率和临床病程，并分析严重VOD的危险因素。设计：355例连续患者的队列研究。设置：骨髓移植center.Measures：每个患者进行了前瞻性评估VOD，严重VOD的许多危险因素进行了分析，采用逻辑回归模型。VOD与肾和心肺功能衰竭的关系进行了分析，使用时间依赖的比例风险models.Results：静脉闭塞性疾病的355例患者中的190（54%; 95%CI，48%至59%）：54例患者有严重的VOD和136例有轻度或中度VOD。从预测严重VOD的多变量模型中得出的自变量包括移植前转氨酶升高值（相对危险度，4.6; P <0.0001）;细胞减灭治疗期间万古霉素治疗（相对风险，2.9; P = 0.003）;高剂量方案的细胞减灭治疗（相对危险度，2.8; P = 0.01）;移植前接受阿昔洛韦治疗（相对风险，4.8; P = 0.02）;不匹配或无关的供者骨髓（相对危险度，2.4; P = 0.02）;和既往腹部放疗（相对危险度，2.2; P = 0.04）。万古霉素治疗是持续发热的标志。VOD患者中多器官功能衰竭更为常见，通常发生在肝脏疾病的发病之后。结论：静脉闭塞性疾病，在54%的骨髓移植受者中发展，经常与肾和心肺功能衰竭相关。移植前转氨酶升高、使用大剂量细胞减灭治疗和细胞减灭治疗期间持续发热是严重VOD的独立预测因素。
Objective: To determine the incidence and clinical course of veno-occlusive disease of the liver (VOD) after bone marrow transplantation and to analyze risk factors for severe VOD.Design: Cohort study of 355 consecutive patients.Setting: A bone marrow transplantation center.Measurements: Each patient was prospectively evaluated for VOD, and many risk factors for severe VOD were analyzed using logistic regression models. The relation of VOD to renal and cardiopulmonary failure was analyzed using time-dependent proportional hazards models.Results: Veno-occlusive disease developed in 190 of 355 patients (54%; 95% CI, 48% to 59%): Fifty-four patients had severe VOD and 136 had mild or moderate VOD. Independent variables derived from a multivariate model for predicting severe VOD included elevated transaminase values before transplantation (relative risk, 4.6; P < 0.0001); vancomycin therapy during cytoreductive therapy (relative risk, 2.9; P = 0.003); cytoreductive therapy with a high-dose regimen (relative risk, 2.8; P = 0.01); acyclovir therapy before transplantation (relative risk, 4.8; P = 0.02); mismatched or unrelated donor marrow (relative risk, 2.4; P = 0.02); and previous radiation therapy to the abdomen (relative risk, 2.2; P = 0.04). Vancomycin therapy was a marker for persistent fever. Multiorgan failure was more frequent among patients with VOD and usually followed the onset of liver disease.Conclusions: Veno-occlusive disease, which developed in 54% of bone marrow transplant recipients, is frequently associated with renal and cardiopulmonary failure. Pretransplant transaminase elevations, use of high-dose cytoreductive therapy, and persistent fever during cytoreductive therapy are independent predictors of severe VOD.