Therapeutic Effect of Artificial Liver Support System on Severe Hepatic Veno-occlusive Disease after Hematopoietic Stem Cell Transplantation_West China Medical Journal

Authors：

SU Yi , FAN Fangyi , YI Hai , LIU Yangyang , DENG Tao , FU Li , SUN Haoping , WANG Yi , HE Guangcui , LAI Sihan , WANG Lin , LIU Yilan

Department of Hematology, Chengdu Military General Hospital, Chengdu, Sichuan 610083, P. R. China;

Corresponding author：

Keywords：

人工肝; 造血干细胞移植; 肝静脉闭塞病

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【摘要】　目的　了解人工肝支持系统抢救造血干细胞移植合并重症肝静脉闭塞病的临床疗效。　方法　对2002年1月-2010年12月因造血干细胞移植并发重症肝静脉闭塞病的6例患者，利用人工肝支持系统，选用血浆置换程序进行血浆置换。　结果　 6例患者经血浆置换治疗后，胆红素均明显下降，3例最终恢复，2例因肝功能再次恶化死亡，1例死于严重混合性感染。　结论　人工肝支持系统抢救造血干细胞移植合并重症肝静脉闭塞病是一种新的尝试，是有效和可靠的。
【Abstract】　Objective　 To explore the therapeutic efficacy of artificial liver support system on severe hepatic veno-occlusive disease accompanied with hematopoietic stem cell transplantation.　Methods　 Between January 2002 and December 2010, six patients with severe hepatic veno-occlusive disease accompanied with hematopoietic stem cell transplantation underwent plasma exchange with plasma exchange procedures using artificial liver support system.　Results　 After plasma exchange treatment, the bilirubins of six patients significantly decreased; three patients eventually recovered, two died because of liver function deteriorated again, and one died of severe mixed infections.　Conclusion　 Artificial liver support system is effective and reliable for hematopoietic stem cell transplantation accompanied with severe hepatic veno-occlusive disease.

Citation： SU Yi,FAN Fangyi,YI Hai,LIU Yangyang,DENG Tao,FU Li,SUN Haoping,WANG Yi,HE Guangcui,LAI Sihan,WANG Lin,LIU Yilan. Therapeutic Effect of Artificial Liver Support System on Severe Hepatic Veno-occlusive Disease after Hematopoietic Stem Cell Transplantation. West China Medical Journal, 2011, 26(12): 1787-1790. doi: Copy

1.	Senzolo M Germani G, Cholongitas E, et al. Veno occlusive disease: update on clinical management[J]. World J Gastroenterol, 2007, 13(29): 3918-3924.
2.	Kalayoglu-Besisik S, Yenerel MN, Caliskan Y, et al. Time-related changes in the incidence, severity, and clinical outcome of hepatic veno-occlusive disease in hematopoietic stem cell transplantation patients during the past 10 years[J]. Transplant Proc, 2005, 37(5): 2285-2289.
3.	Mcdonald GB, Sharma P, Matthews DE, et al. Venocclusive disease of the liver after bone marrow transplantation: diagnosis, incidence, and predisposing factors[J]. Hepatology, 1984, 4(1): 116-122.
4.	Jones RJ, Lee KS, Beschorner WE, et al. Venoocclusive disease of the liver following bone marrow transplantation[J]. Transplantation, 1987, 44(6): 778-783.
5.	Bearman SI. The syndrome of hepatic veno-occlusive disease after marrow transplantation[J]. Blood, 1995, 85(11): 3005-3020.
6.	Li CK, Shing MM, Chik KW, et al. Haematopoietic stem cell transplantation for thalassaemia major in Hong Kong: prognostic factors and outcome[J]. Bone Marrow Transplant, 2002, 29(2): 101-105.
7.	Armand P, Kim H, Cutler C, et al. Prognostic impact of elevated pre-transplant serum ferritin in patients undergoing myeloablative stem eell transplantation[J]. Blood, 2007, 109(10): 4586-4588.
8.	Wadleigh M, Richardson PG, Zahrieh D, et al. Prior gcmtuzumab ozogamicin exposure significantly increases the risk of veno-occlusive disease in patients who undergo myeloablative allogeneic stem cell transplantation[J]. Blood, 2003, 102(5): 1578-1582.
9.	Eissner G, Multhoff G, Gerbitz A, et al. Fludarabine induces apoptosis, activation, and allogenicity in human endothelial and epithelial cells: protective effect of defibrotide[J]. Blood, 2002, 100(1): 334-340.
10.	Chalandon Y, Roosnek E, Mermillod B, et al. Prevention of veno-occlusive disease with defibrotide after allogeneie stem cell transplantation[J]. Biol Blood Marrow Transplant, 2004, 10(5): 347-354.
11.	Dignan F, Gujral D, Ethell M, et al. Prophylactic defibrotide in allogeneic stem cell transplantation: minimal morbidity and zero mortality from veno-occlusive disease[J]. Bone Marrow Transplant, 2007, 40(1): 79-82.
12.	董敏, 林曲, 吴祥元, 等. 异基因造血干细胞移植后肝静脉闭塞病的防治效果分析[J]. 癌症, 2008, 27(6): 646-649.
13.	Richardson PG, Soiffer RJ, Antin JH, et al. Defibrotide for the treatment of severe hepatic veno-occlusive disease and multiorgan failure after stem cell transplantation: a multicenter, randomized, dose-finding trial[J]. Biol Blood Marrow Transplant, 2010, 16(7): 1005-1017.
14.	Al Beihany A, Al Omar H, Sahovic E, et al. Successful treatment of hepatic veno-occlusive disease after myeloablative allogeneic hematopoietic stem cell ransplantation by early administration of a short course of methylprednisolone[J]. Bone Marrow Transplant, 2008, 41(3): 287-291.
15.	李兰娟, 黄建容, 陈江华. 人工肝支持系统治疗重型病毒性肝炎的研究[J]. 中华肝病杂志, 1997, 5(4): 202.

1. 　Senzolo M Germani G, Cholongitas E, et al. Veno occlusive disease: update on clinical management[J]. World J Gastroenterol, 2007, 13(29): 3918-3924.
2. 　Kalayoglu-Besisik S, Yenerel MN, Caliskan Y, et al. Time-related changes in the incidence, severity, and clinical outcome of hepatic veno-occlusive disease in hematopoietic stem cell transplantation patients during the past 10 years[J]. Transplant Proc, 2005, 37(5): 2285-2289.
3. 　Mcdonald GB, Sharma P, Matthews DE, et al. Venocclusive disease of the liver after bone marrow transplantation: diagnosis, incidence, and predisposing factors[J]. Hepatology, 1984, 4(1): 116-122.
4. 　Jones RJ, Lee KS, Beschorner WE, et al. Venoocclusive disease of the liver following bone marrow transplantation[J]. Transplantation, 1987, 44(6): 778-783.
5. 　Bearman SI. The syndrome of hepatic veno-occlusive disease after marrow transplantation[J]. Blood, 1995, 85(11): 3005-3020.
6. 　Li CK, Shing MM, Chik KW, et al. Haematopoietic stem cell transplantation for thalassaemia major in Hong Kong: prognostic factors and outcome[J]. Bone Marrow Transplant, 2002, 29(2): 101-105.
7. 　Armand P, Kim H, Cutler C, et al. Prognostic impact of elevated pre-transplant serum ferritin in patients undergoing myeloablative stem eell transplantation[J]. Blood, 2007, 109(10): 4586-4588.
8. 　Wadleigh M, Richardson PG, Zahrieh D, et al. Prior gcmtuzumab ozogamicin exposure significantly increases the risk of veno-occlusive disease in patients who undergo myeloablative allogeneic stem cell transplantation[J]. Blood, 2003, 102(5): 1578-1582.
9. 　Eissner G, Multhoff G, Gerbitz A, et al. Fludarabine induces apoptosis, activation, and allogenicity in human endothelial and epithelial cells: protective effect of defibrotide[J]. Blood, 2002, 100(1): 334-340.
10. 　Chalandon Y, Roosnek E, Mermillod B, et al. Prevention of veno-occlusive disease with defibrotide after allogeneie stem cell transplantation[J]. Biol Blood Marrow Transplant, 2004, 10(5): 347-354.
11. 　Dignan F, Gujral D, Ethell M, et al. Prophylactic defibrotide in allogeneic stem cell transplantation: minimal morbidity and zero mortality from veno-occlusive disease[J]. Bone Marrow Transplant, 2007, 40(1): 79-82.
12. 　董敏, 林曲, 吴祥元, 等. 异基因造血干细胞移植后肝静脉闭塞病的防治效果分析[J]. 癌症, 2008, 27(6): 646-649.
13. 　Richardson PG, Soiffer RJ, Antin JH, et al. Defibrotide for the treatment of severe hepatic veno-occlusive disease and multiorgan failure after stem cell transplantation: a multicenter, randomized, dose-finding trial[J]. Biol Blood Marrow Transplant, 2010, 16(7): 1005-1017.
14. 　Al Beihany A, Al Omar H, Sahovic E, et al. Successful treatment of hepatic veno-occlusive disease after myeloablative allogeneic hematopoietic stem cell ransplantation by early administration of a short course of methylprednisolone[J]. Bone Marrow Transplant, 2008, 41(3): 287-291.
15. 　李兰娟, 黄建容, 陈江华. 人工肝支持系统治疗重型病毒性肝炎的研究[J]. 中华肝病杂志, 1997, 5(4): 202.

West China Medical Journal

Therapeutic Effect of Artificial Liver Support System on Severe Hepatic Veno-occlusive Disease after Hematopoietic Stem Cell Transplantation

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