VENO-OCCLUSIVE DISEASE OF THE LIVER AFTER ALLOGENEIC BONE-MARROW TRANSPLANTATION - POSSIBLE ASSOCIATION WITH GRAFT VERSUS HOST DISEASE

Acute veno-occlusive disease of the liver developed in 7 of 29 patients undergoing bone marrow transplantation for treatment of leukemia, aplastic anemia, or disseminated carcinomatosis. All 7 died despite successful marrow engraftment. Hepatic failure was the principal cause of death in 4 and contributory in 3. The veno-occlusive disease did not relate to the nature of the pretransplant immunosuppressive regimen, since it occurred in patients receiving irradiation alone, chemotherapy alone, or both. 22 of the patients were autopsied. Among these, the lesion was found in 7 of 11 in whom a graft-versus-host reaction developed but in none of the 11 without such a reaction who had received similar pretransplant immunosuppression (P <0.025). Hence, acute veno-occlusive disease of the liver appears to be a complication of allogeneic bone marrow transplantation related to the development of a graft-versus-host reaction.