Hepatic veno-occlusive disease following stem cell transplantation: incidence, clinical course, and outcome.
Hepatic veno-occlusive disease following stem cell transplantation: incidence, clinical course, and outcome.
复制标题
DOI：
10.1016/j.bbmt.2009.08.024
复制
发表时间：
2010-02
影响因子：
4.3
通讯作者：
Niederwieser, Dietger
中科院分区：
文献类型：
--
作者：
Coppell, Jason A.;Richardson, Paul G.;Soiffer, Robert;Martin, Paul L.;Kernan, Nancy A.;Chen, Allen;Guinan, Eva;Vogelsang, Georgia;Krishnan, Amrita;Giralt, Sergio;Revta, Carolyn;Carreau, Nicole A.;Iacobelli, Massimo;Carreras, Enric;Ruutu, Tapani;Barbui, Tiziano;Antin, Joseph H.;Niederwieser, Dietger
据报道，干细胞移植(SCT)后高达60%的患者发生了肝静脉闭塞疾病(VOD)，根据移植类型、预适应方案和诊断标准的不同，研究之间的发生率差异很大。严重VOD的特点是高死亡率和进展为多器官衰竭(MOF)；然而，对于如何评估严重程度还没有达成共识。这篇对已发表报告的回顾和分析试图通过计算VOD的总体平均发病率和严重VOD的死亡率，检查SCT实践的变化对VOD发生率的影响，并讨论用于评估严重程度的方法来澄清这些问题。在1979年至2007年10月期间进行的135项研究中，VOD的总体平均发病率为13.7%(95%可信区间[CI]=13.3%-14.1%)。1979-1994年VOD的平均发病率显著低于1994-2007年(11.5%[95%CI，10.9%-12.1%]vs 14.6%[95%CI，14.0%-15.2%]；P<；0.05)。重度VOD的病死率为84.3%(95%CI，79.6%~88.9%)，多器官功能衰竭也是最常见的死亡原因。因此，VOD并不像早期报道所认为的那样常见，但目前的发病率似乎相对稳定，尽管SCT最近取得了进展，包括出现了降低强度的条件反射。SCT后VOD时MOF的演变可以被认为是病情严重程度的可靠指标和预后不良的预测指标。
The occurrence of hepatic veno-occlusive disease (VOD) has been reported in up to 60% of patients following stem cell transplantation (SCT), with incidence varying widely between studies depending on the type of transplant, conditioning regimen, and criteria used to make the diagnosis. Severe VOD is characterized by high mortality and progression to multiorgan failure (MOF); however, there is no consensus on how to evaluate severity. This review and analysis of published reports attempts to clarify these issues by calculating the overall mean incidence of VOD and mortality from severe VOD, examining the effect of changes in SCT practice on the incidence of VOD over time, and discussing the methods used to evaluate severity. Across 135 studies performed between 1979 and October 2007, the overall mean incidence of VOD was 13.7% (95% confidence interval [CI] = 13.3%–14.1%). The mean incidence of VOD was significantly lower between 1979–1994 than between 1994–2007 (11.5% [95% CI, 10.9%–12.1%] vs 14.6% [95% CI, 14.0%–15.2%]; P < .05). The mortality rate from severe VOD was 84.3% (95% CI, 79.6%–88.9%); most of these patients had MOF, which also was the most frequent cause of death. Thus, VOD is less common than early reports suggested, but the current incidence appears to be relatively stable despite recent advances in SCT, including the advent of reduced-intensity conditioning. The evolution of MOF in the setting of VOD after SCT can be considered a reliable indication of severity and a predictor of poor outcome.
登录
查看更多内容
影响因子：
2.1
作者：
Aversa, F;Terenzi, A;Martelli, MF
通讯作者：
Martelli, MF
影响因子：
45.3
作者：
BEARMAN, SI;ANDERSON, GL;MCDONALD, GB
通讯作者：
MCDONALD, GB
影响因子：
7.5
作者：
Batsis, Ioannis;Yannaki, Evangelia;Anagnostopoulos, Achilles
通讯作者：
Anagnostopoulos, Achilles
影响因子：
2.6
作者：
Brice, Kitio;Valerie, Bertholle;Nathalie, Bleyzac
通讯作者：
Nathalie, Bleyzac
影响因子：
4.3
作者：
Bartelink, Imke H.;Bredius, Robbert G. M.;Boelens, Jaap J.
通讯作者：
Boelens, Jaap J.