Low incidence of hepatic veno‐occlusive disease in pediatric patients undergoing hematopoietic stem cell transplantation attributed to a combination of intravenous heparin,oral glutamine,and ursodiol at a single transplant institution

Lakshminarayanan S, Sahdev I, Goyal M, Vlachos A, Atlas M, Lipton JM. Low incidence of hepatic veno‐occlusive disease in pediatric patients undergoing hematopoietic stem cell transplantation attributed to a combination of intravenous heparin, oral glutamine, and ursodiol at a single transplant institution.
Pediatr Transplantation 2010: 14:618–621. © 2009 John Wiley & Sons A/S. Abstract: We report the low incidence of hepatic VOD in pediatric patients with various diagnoses including hematologic malignancies and non‐malignant conditions transplanted at our institution. Retrospective review of 188 patients who underwent HSCT and received a combined prophylactic regimen of intravenous heparin, oral glutamine, and ursodiol was undertaken. Analysis of the outcome of VOD revealed only one clinical case with acute myeloid leukemia; the patient developed hepatic VOD 10 days after receiving myeloablative chemotherapy with busulfan and CTX followed by HLA‐matched related peripheral blood stem cell transplantation. The low incidence of hepatic VOD in an otherwise high‐risk pediatric transplant population is an important observation, which may be partly attributed to this prophylactic regimen, and warrants further randomized clinical trials for confirmation.