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Experience from a single paediatric transplant centre with identification of some protective and risk factors concerning the development of hepatic veno-occlusive disease in children after allogeneic hematopoietic stem cell transplant

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Abstract

Hepatic veno-occlusive disease (VOD) is a frequent and severe complication of hematopoietic stem cell transplantation (HSCT) affecting 9.6–17.3 % of cases. 200 HSCT, performed between January 1995 and March 2013 in our Paediatric HSCT Centre in Trieste, were retrospectively analysed to evaluate the frequency of VOD and to identify the associated risk factors. The frequency of VOD according to the Seattle criteria was 17 %, within the range reported in literature. The mortality rate was 37.5 % (75 out of 200 transplantations) in the general population and 73.5 % (25 out of 34) in VOD patients (p < 0.05). Veno-occlusive disease significantly decreased from 38 % (1995–2000) to 8 % (2007–2013) p < 0.05. Univariate and multivariate analyses identified sepsis and pre-transplant ferritin levels above 1000 ng/ml as two significant risk factors for VOD, while the use of tacrolimus appeared to be associated with a lower VOD risk. Veno-occlusive disease still remains an important cause of transplant-related mortality even if it appears to have decreased over the last few years.

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Abbreviations

VOD:

Veno occlusive disease

HSCT:

Hematopoietic stem cell transplantation

MOF:

Multi-organ failure

GVHD:

Graft versus host disease

DF:

Defibrotide

CY-A:

Cyclosporin

FK-506:

Tacrolimus

BU:

Busulfan

TBI:

Total body irradiation

MTX:

Methotrexate

MMF:

Mycophenolate mofetil

UDCA:

Ursodeoxycholic acid

NAC:

N-Acetyl-cysteine

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The authors declare no financial or other conflict of interest.

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Authors and Affiliations

  1. University of Trieste, Trieste, Italy

    G. Ferrara, M. Minute & P. Tamaro

  2. Institute for Maternal and Child Health IRCCS “Burlo Garofolo”, Via dell’Istria 65/1, 34137, Trieste, Italy

    N. Maximova, A. Pizzol, V. Kiren, M. Montico, M. Gregori & P. Tamaro

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  1. N. Maximova
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  2. G. Ferrara
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  3. M. Minute
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  7. M. Gregori
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Correspondence to N. Maximova.

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Maximova, N., Ferrara, G., Minute, M. et al. Experience from a single paediatric transplant centre with identification of some protective and risk factors concerning the development of hepatic veno-occlusive disease in children after allogeneic hematopoietic stem cell transplant. Int J Hematol 99, 766–772 (2014). https://doi.org/10.1007/s12185-014-1578-y

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  • DOI: https://doi.org/10.1007/s12185-014-1578-y

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