Plasma levels of D-dimer and circulating endothelial adhesion molecules in veno-occlusive disease of the liver following allogeneic bone marrow transplantation |
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Authors: | Thomas Sü dhoff,Michael Heins,Dietmar S hngen,Viola Lenz,Artur Wehmeier,Gerald Meckenstock,Wolfgang Schneider,Hans Reinauer,Axel Heyll,Carlo Aul |
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Affiliation: | Thomas Südhoff,Michael Heins,Dietmar Söhngen,Viola Lenz,Artur Wehmeier,Gerald Meckenstock,Wolfgang Schneider,Hans Reinauer,Axel Heyll,Carlo Aul |
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Abstract: | Abstract: Veno-occlusive disease (VOD) of the liver is a frequent and life-threatening complication of BMT. Recently, successful treatment by t-PA has been reported but has been compromised by fatal bleeding events. Therefore, t-PA application should be restricted to patients with severe VOD. However, moderate and severe forms of VOD are difficult to distinguish in early stages. We analyzed plasma levels of cross-linked fibrin degradation products (D-dimer) and soluble endothelial adhesion molecules such as sE-selectin, sVCAM-1 and sICAM-1 in 10 consecutive patients undergoing allogeneic BMT to evaluate their use in identifying severe forms of VOD. During the observation period, 4 episodes of VOD occurred, 2 of which were fatal due to early onset of multiorgan failure. Concentrations of D-dimer generally increased after transplantation. However, there was an additional significant increase in D-dimer levels during severe VOD. Thus, D-dimer levels above 1000 μg/1 were only found in 2 cases with severe VOD and fatal outcome. When compared with bilirubin concentrations substantial increases of D-dimers appeared earlier during the course of severe VOD. In contrast, VOD episodes were not accompanied by significant increases in sE-selectin, sVCAM-1 and sICAM-1 levels. It is concluded that measurement of D-dimer concentrations may aid accuracy to the early diagnosis of severe VOD. |
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Keywords: | VOD D-dimer ICAM-1 VCAM-1 E-selectin allogeneic BMT |
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