Utility of Transvenous Liver Biopsies and Wedged Hepatic Venous Pressure Measurements in Sixty Marrow Transplant Recipients

Shulman, Howard M.; Gooley, Ted; Dudley, Matthew W.; Kofler, T; Feldman, Roger A.; Dwyer, Diane M.; McDonald, George B.

doi:10.1097/00007890-199504150-00017

Cited by 158 publications

(100 citation statements)

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“…15 Also, the transvenous wedged hepatic venous pressure measurements are highly specific but only moderately sensitive for VOD. 16 Numerous plasma and serum proteins have been reported to be abnormal in VOD patients including coagulation proteins and procollagen peptides. 17 In many retrospective analyses the natural anticoagulant PC, 8,5 synthesized and released by hepatocytes, and the serum aminopropeptide of type III procollagen, accumulating in enhanced collagen formation, were analyzed to figure out whether they were useful markers of hepatic VOD after HSCT.…”

Section: Discussionmentioning

confidence: 99%

Protein C and procollagen III peptide levels in patients with hepatic dysfunction after allogeneic hematopoietic stem cell transplantation

Pihusch

Wegner²,

Goehring

et al. 2005

Bone Marrow Transplant

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Summary:Veno-occlusive disease (VOD) is one of the most serious complications following hematopoietic stem cell transplantation (HSCT) and is associated with a high mortality. We conducted a large trial on the clinical significance of protein C (PC) and procollagen III peptide (PNPIII) levels, which have been described as possible diagnostic markers of VOD. In total, 350 patients undergoing allogeneic HSCT were included. PC and PNPIII levels were analyzed prior to conditioning and weekly until 8 weeks after the HSCT. Signs of VOD and other transplantation-related complications (graft-versushost disease (GVHD), toxicity, microangiopathic hemolytic anemia, infection) were recorded weekly throughout the trial. Patients showed a significant drop of the PC levels in VOD (70.3 vs 96.3%, Po0.001) and with increasing severity of aGVHD. Steroids increased the PC levels (69.4% vs 109.4%, Po0.001). The highest PNPIII levels were registered in patients with VOD (mean 6.3 IU/ ml). Patients with aGVHD showed an elevation of PNPIII, especially patients with hepatic aGVHD. PC levels during conditioning do not predict VOD (98.5 vs 76.5%, NS). Although PC and PNPIII may play a role in the pathogenesis of VOD they cannot discriminate between complications with jaundice and are only of limited help in the differential diagnosis of VOD. Bone Marrow Transplantation (2005) 36, 631-637.

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Section: Discussionmentioning

confidence: 99%

Protein C and procollagen III peptide levels in patients with hepatic dysfunction after allogeneic hematopoietic stem cell transplantation

Pihusch

Wegner²,

Goehring

et al. 2005

Bone Marrow Transplant

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“…Patients with VOD develop portal hypertension, with portal pressures that are similar to those in patients with end-stage cirrhosis of the liver. 24,25 There is no direct evidence, however, that platelets are sequestered in the spleen of patients with VOD.…”

Section: Discussionmentioning

confidence: 99%

Plasma thrombopoietin levels in marrow transplant patients with veno-occlusive disease of the liver

Tahara

Bouvier

et al. 1998

Bone Marrow Transplant

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Summary:Platelet transfusion requirements are higher among patients with veno-occlusive disease (VOD), compared to patients without VOD. One possible explanation is inadequate production of thrombopoietin (TPO), a protein synthesized in the liver. We prospectively studied 28 patients to test the hypothesis that plasma TPO levels were decreased in patients who developed VOD. Plasma TPO levels to day +30 were measured by ELISA (normal, 0.36 ؎ 0.15 fmol/ml). VOD developed in 18/28 patients. Platelet transfusion requirements were significantly different in patients with and without VOD (97 ؎ 46.1 units vs 51 ؎ 33.2 units, P = 0.008). Plasma TPO levels were elevated at baseline (10.8 ؎ 13.0 fmol/ml) and increased after transplant, with peak values of 32.3 ؎ 10.3 fmol/ml at day +7. TPO levels were significantly higher at days +7 and +17 among patients with VOD than among those without VOD (P Ͻ 0.01). Regression analysis of TPO levels vs platelet counts showed a significant inverse relationship. We conclude that TPO levels were higher in patients with VOD and were inversely correlated with platelet counts, suggesting that regulation of TPO levels was related to platelet mass. Thrombocytopenia in patients with VOD cannot be explained by inadequate hepatic synthesis of TPO. Keywords: thrombopoietin; thrombocytopenia; platelets; marrow transplantation; cytoreductive therapy; venoocclusive disease Veno-occlusive disease of the liver (VOD) is a clinical syndrome caused by high-dose cytoreductive therapy that is used to prepare patients for hematopoietic stem cell transplantation. 1 The clinical signs and symptoms of VOD (hepatomegaly, weight gain and jaundice) are a result of widespread damage to hepatocytes, sinusoidal endothelial cells, and venular endothelium in zone 3 of the liver acinus. 2 Another prominent feature of patients with VOD is thrombocytopenia. Platelet transfusion requirements are significantly higher in the first 20 days post transplant The mechanisms for thrombocytopenia in patients with VOD are not well understood. There are three possibilities: underproduction of platelets, more rapid destruction, or a combination of these. Cytoreductive therapy greatly reduces host megakaryocytes and platelet production is decreased until engraftment of donor platelet progenitor cells. Thrombocytopenia is therefore an expected consequence of myeloablative therapy, but patients with VOD require more transfused platelets than patients who do not develop VOD, suggesting that there is increased destruction of platelets in the early phases of VOD. However, even after engraftment, patients with VOD often remain thrombocytopenic. 3 One possible explanation is inadequate production of thrombopoietin, a protein synthesized predominantly in the liver 5 and the most important physiological regulator of platelet homeostasis. 6 Several investigators have reported increased blood levels of TPO following hematopoietic stem cell transplantation. 7-9 However, one report noted significantly lower TPO levels after transplant among patie...

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“…136 Veno-occlusive disease (VOD) is also associated with other toxins and drugs such as alcohol, oral contraceptives, organ transplantation, because HVPG is high in VOD. 146 A HVPG > 20 mmHg is correlated with poor prognosis. 147 Transjugular liver biopsy can be done at the time of HVPG measurement and diagnosis confirmed.…”

Section: Hepatic Veno-occlusive Disease (Sinusoidal Obstruction Syndrmentioning

confidence: 97%

“…145 Interestingly, the thickness of gallbladder wall has been shown to correlate with HVPG in these patients. 146 Moreover, HVPG can help discriminate between graftversus-host disease and VOD, especially after SCT or During the course of the disease, portal hypertension frequently develops and may be complicated by variceal bleeding. Less common, an episode of gastrointestinal bleeding is the first presenting sign of BCS.…”

Section: Investigationsmentioning

confidence: 99%

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Noncirrhotic Portal Hypertension

Rajekar¹,

Vasishta²,

Chawla³

et al. 2011

Journal of Clinical and Experimental Hepatology

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Portal hypertension is characterized by an increase in portal pressure (> 10 mmHg) and could be a result of cirrhosis of the liver or of noncirrhotic diseases. When portal hypertension occurs in the absence of liver cirrhosis, noncirrhotic portal hypertension (NCPH) must be considered. The prognosis of this disease is much better than that of cirrhosis. Noncirrhotic diseases are the common cause of portal hypertension in developing countries, especially in Asia. NCPH is a heterogeneous group of diseases that is due to intrahepatic or extrahepatic etiologies. In general, the lesions in NCPH are vascular in nature and can be classified based on the site of resistance to blood flow. In most cases, these disorders can be explained

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Utility of Transvenous Liver Biopsies and Wedged Hepatic Venous Pressure Measurements in Sixty Marrow Transplant Recipients

Cited by 158 publications

References 0 publications

Protein C and procollagen III peptide levels in patients with hepatic dysfunction after allogeneic hematopoietic stem cell transplantation

Protein C and procollagen III peptide levels in patients with hepatic dysfunction after allogeneic hematopoietic stem cell transplantation

Plasma thrombopoietin levels in marrow transplant patients with veno-occlusive disease of the liver

Noncirrhotic Portal Hypertension

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