1. Prophylactic fresh frozen plasma may prevent development of hepatic VOD after stem cell transplantation via ADAMTS13-mediated restoration of von Willebrand factor plasma levels
- Author
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Masanori Matsumoto, Ayami Isonishi, Hiroyasu Ogawa, Junichi Hara, S. Fukuhara, Akira Hiraoka, Shunro Kai, Yasuhiro Takeshima, Keisei Kawa, Yoshihiro Fujimura, Park Yd, Hiromichi Ishizashi, Hiroshi Hara, Masahiro Sako, Yoshiyuki Kosaka, Masayuki Hino, Akihisa Kanamaru, M. Uemura, Seiji Kato, and Hideo Yagi
- Subjects
Adult ,Male ,medicine.medical_specialty ,Adolescent ,Hepatic Veno-Occlusive Disease ,ADAMTS13 Protein ,Gastroenterology ,law.invention ,Plasma ,Von Willebrand factor ,Randomized controlled trial ,law ,hemic and lymphatic diseases ,Internal medicine ,von Willebrand Factor ,Blood plasma ,medicine ,Humans ,Child ,Transplantation ,Hematology ,biology ,business.industry ,Case-control study ,Infant ,Middle Aged ,ADAMTS13 ,Surgery ,ADAM Proteins ,Case-Control Studies ,Child, Preschool ,Hematologic Neoplasms ,biology.protein ,Fresh frozen plasma ,business ,Stem Cell Transplantation - Abstract
We initially conducted a multicenter, randomized trial (n=43), and subsequently a questionnaire study (n=209) of participating hospitals, to evaluate whether infused fresh frozen plasma (FFP) could prevent the occurrence of hepatic veno-occlusive disease (VOD) after stem cell transplantation (SCT). Forty-three patients were divided into two groups: 23 receiving FFP infusions and 20 not receiving it. VOD developed in three patients not receiving FFP. Plasma von Willebrand factor (VWF) antigen levels were lower at days 0, 7 and 28 after SCT in patients receiving FFP than in those not receiving it, whereas plasma ADAMTS13 activity (ADAMTS13:AC) did not differ between them. Plasma VWF multimer (VWFM) was demonstrated to be defective in the high approximately intermediate VWFM during the early post-SCT phase, but there was a significant increase in high VWFM just before VOD onset. This suggests that a relative enzyme-to-substrate (ADAMTS13/high-VWFM) imbalance is involved in the pathogenesis of VOD. To strengthen this hypothesis, the incidence of VOD was apparently lower in patients receiving FFP infusions than in those not receiving it (0/23 vs 3/20) in the randomized trial. Further, the results combined with the subsequent questionnaire study (0/36 vs 11/173) clearly showed the incidence to be statistically significant (0/59 vs 14/193, P=0.033).
- Published
- 2007
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