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Fulminant liver failure due to severe veno-occlusive disease after haematopoietic cell transplantation: a depressing experience MacQuillan GC; Mutimer DQJM 2004[Sep]; 97 (9): 581-9BACKGROUND: Between 1988 and 2002, eight patients were referred to our unit from other institutions, for management of fulminant hepatic failure (FHF) complicating severe veno-occlusive disease (VOD). AIM: To review our experience with these patients. METHODS: Retrospective analysis of medical case notes. RESULTS: In 7/8 cases, a histological diagnosis of VOD was confirmed by transjugular liver biopsy or post-mortem examination. All had undergone high-dose chemotherapy. Cyclophosphamide was included in the conditioning regimen of six patients. All developed encephalopathy and four progressed to grade 3 or 4 encephalopathy. All patients died, none surviving >75 days after haematopoietic cell transplantation. Three were listed for liver transplantation: one underwent transplantation, and two died before transplantation could be performed. Two suffered significant complications of transjugular liver biopsy. One underwent transjugular intrahepatic porto-systemic venous stent (TIPS) insertion. DISCUSSION: FHF complicating severe VOD is associated with multi-organ failure, and has a very poor prognosis. Our experience and that described in published literature, questions the benefits of measures such as liver transplantation or prolonged intensive care.|Adult[MESH]|Fatal Outcome[MESH]|Female[MESH]|Hematopoietic Stem Cell Transplantation/*methods[MESH]|Hepatic Veno-Occlusive Disease/*complications/mortality[MESH]|Humans[MESH]|Liver Failure/*etiology/mortality[MESH]|Male[MESH]|Middle Aged[MESH]|Postoperative Complications/*etiology/mortality[MESH]|Retrospective Studies[MESH] |
