조혈모세포 이식 후 발생한 간정맥폐색성 질환에서 Tissue Plasminogen Activator의 치료 효과

Abstract

Background : Hepatic veno-occlusive disease (VOD) is one of the major morbidity and mortality after hematopoietic stem cell transplantation. It has been shown that thrombolytic therapy using recombinant human tissue plasminogen activator (tPA) is a promising specific treatment for this potentially fatal complications. We evaluated clinical characteristics of patients with VOD, clinical manifestations and therapeutic response of VOD to tPA in our transplant patients. Methods : 73 cases received hematopoietic stem cell transplantation during 6-year period from December 1991. Pentoxifylline and low dose heparin infusion were used as a Preventive measure of VOD. Results : Hepatic reno-occlusive disease has occurred in 10 cases (7 moderate, 3 severe). The incidence was 17.5% in hematologic malignancy and 0% in severe aplastic anemia (p=0.071). Busulfan plus cyclophosphamide conditioning was associated with significant VOD risk (p=0.001). All VOD patients were treated with tPA (10-25 mg/d for 4 days) and successful resolution was achieved in 70% of patients without significant bleeding complications. Conclusion : Hepatic VOD can be successfully treated with tPA in significant proportion of cases. VOD cases with severe manifestations should be treated early in the course of the disease.