TIPS for Venoocclusive Disease Following Stem Cell Transplantation

Zusammenfassung

Venoocclusive disease (VOD) kann als Komplikation der Stammzelltransplantation auftreten. Dem Doppler-Ultraschall wird ein prognostischer Wert bei VOD zugeschrieben. Wir berichten über eine 39-jährige Patientin mit VOD nach allogener Stammzelltransplantation wegen einer akuten myeloischen Leukämie. Der Zustand der Patientin verschlechterte sich rasch und eine medikamentöse Therapie mit Defibrotide blieb erfolglos. Trotzdem war das progrediente Geschehen nicht an wiederholten Doppler-Ultraschall-Untersuchungen ablesbar. 19 Tage nach Stammzelltransplantation wurde als Ultima Ratio ein transjugulärer intrahepatischer portosystemischer Shunt (TIPS) gelegt. Im weiteren Verlauf besserte sich die VOD. Der Verlauf der VOD ist oft schwer vorhersagbar. Bei schwerem Verlauf ist nach Ausschöpfen der medikamentösen Therapie die TIPS-Implantation eine therapeutische Option.

Abstract

Hepatic venoocclusive disease (VOD) is a complication of allogeneic blood stem cell transplantation (SCT). Duplex ultrasound has been proposed to predict the outcome of VOD. We report here the case of a 39-year-old female patient with VOD following allogeneic SCT for AML. Repeated Doppler ultrasound examinations did not indicate a high-risk profile. However, the patient’s condition deteriorated and was refractory to medical therapy. Transjugular intrahepatic portosystemic shunting (TIPS) was performed 19 days after transplantation and VOD resolved subsequently. VOD often has an unpredictable course. Transjugular intrahepatic portosystemic shunts may prove beneficial for patients with refractory disease.

Venoocclusive disease - Doppler-Ultraschall - transjugulärer intrahepatischer portosystemischer Shunt

Venoocclusive disease - Doppler ultrasound - transjugular intrahepatic portosystemic shunt

References

• 1 Shulman H M, Fisher L B, Schoch H G. et al . Venoocclusive disease of the liver after marrow transplantation: histologic correlates of clinical signs and symptoms.  Hepatology. 1994;  19 1171-1180
• 2 Jones R J, Lee K S, Beschorner W E. et al . Venoocclusive disease of the liver following bone marrow transplantation.  Transplantation. 1987;  44 778-783
• 3 McDonald G B, Hinds M S, Fisher L D. et al . Veno-occlusive disease of the liver and multi-organ failure after bone marrow transplantation: A cohort study of 355 patients.  Ann Intern Med. 1993;  118 255-267
• 4 Bearman S I, Anderson G L, Mori M. et al . Venoocclusive disease of the liver: development of a model for predicting fatal outcome after marrow transplantation.  J Clin Oncol. 1993;  11 1729-1736
• 5 Shulman H M, Gooley T, Dudley M D. et al . Utility of transvenous liver biopsies and wedged hepatic venous pressure gradient in sixty marrow transplant recipients.  Transplantation. 1995;  59 1015-1022
• 6 Lassau N, Auperin A, Leclere J. et al . Prognostic value of Doppler-ultrasonography in hepatic veno-occlusive disease.  Transplantation. 2002;  74 60-66
• 7 Hagglund H, Ringden O, Ericzon B G. et al . Treatment of hepatic venoocclusive disease with recombinant human tissue plasminogen activator or orthotopic liver transplantation after allogeneic bone marrow transplantation.  Transplantation. 1996;  62 1076-1080
• 8 Richardson P G, Murakami C, Jin Z. et al . Multi-institutional use of defibrotide in 88 patients after stem cell transplantation with severe veno-occlusive disease and multisystem organ failure: response without significant toxicity in a high-risk population and factors predictive of outcome.  Blood. 2002;  100 4337-4343
• 9 Rajvanshi P, McDonald G B. Expanding the use of transjugular intrahepatic portosystemic shunts for veno-occlusive disease.  Liver Transplant. 2001;  7 154-157
• 10 Lassau N, Leclere J, Auperin A. et al . Hepatic veno-occlusive disease after myeloablative treatment and bone marrow transplantation: value of gray-scale and Doppler ultrasound in 100 patients.  Radiology. 1997;  204 545-552
• 11 Carreras E, Granena A, Rozman C. Hepatic veno-occlusive disease after bone marrow transplant.  Blood Rev. 1993;  7 43-51
• 12 Nicolau C, Bru C, Carreras E. et al . Sonographic diagnosis and hemodynamic correlation in veno-occlusive disease of the liver.  J Ultrasound Med. 1993;  12 437-440
• 13 Zenz T, Rössle M, Bertz H. et al . Severe veno-occlusive disease after allogeneic bone marrow or peripheral stem cell transplantation - role of transjugular intrahepatic portosystemic shunt (TIPS).  Liver. 2001;  21 31-36
• 14 Azoulay D, Castaing D, Lemoine A. et al . Transjugular intrahepatic portosystemic shunt (TIPS) for severe veno-occlusive disease of the liver following bone marrow transplantation.  Bone Marrow Transplant. 2000;  25 987-992