Platelet transfusion containing ABO-incompatible plasma and hepatic veno-occlusive disease after hematopoietic transplantation in young children.

Abstract

BACKGROUND:

Hepatic veno-occlusive disease is a major limiting factor of high-dose chemotherapy in children. The cells lining the hepatic vascular endothelium express blood group A and/or B antigens according to the patient's blood group. We designed a study evaluating the impact of platelet concentrates containing ABO-incompatible plasma transfused to young children with a high risk of hepatic veno-occlusive disease.

METHODS:

In all, 186 consecutive children (median age: 4 years, range: 0.75-17 years), treated with high-dose chemotherapy containing busulfan followed by hematopoietic stem cell transplantation for neuroblastoma (n=112) or brain tumor (n=74) between 1988 and 1998, were investigated. The main endpoint was the occurrence of hepatic veno-occlusive disease. Multivariate analysis was performed using a Cox's regression model with transfusion of platelet concentrates containing ABO-incompatible plasma as a time-dependent covariate.

RESULTS:

We found that 73 out of 186 (39%) children developed hepatic veno-occlusive disease after transplantation. Multivariate analysis demonstrated that two factors significantly increased the risk of hepatic veno-occlusive disease occurrence: transfusion of platelet concentrates containing ABO-incompatible plasma (P=0.003) and use of melphalan in the conditioning regimen (P=0.006). Conversely, the number of platelet concentrates transfusions per week, child's age, weight, sex, and use of cyclophosphamide in the conditioning regimen had no effect.

CONCLUSIONS:

Transfusion of platelet concentrates containing ABO-incompatible plasma increases the risk of hepatic veno-occlusive disease in young children treated with a busulfan-containing regimen. Binding of A and/or B antigens expressed on the surface of hepatic endothelial cells may promote this complication. Transfusion of platelet concentrates containing ABO-incompatible plasma should be avoided in these children.

• Authors: Valérie Lapierre, Cédric Mahé, Anne Aupérin, Férial Stambouli, Nadia Oubouzar, Dominique Tramalloni, Ellen Benhamou, Pierre Tiberghien, Olivier Hartmann
• Journal: Transplantation (Transplantation) Vol. 80 Issue 3 Pg. 314-9 (Aug 15 2005) ISSN: 0041-1337 [Print] United States
• PMID: 16082325 (Publication Type: Journal Article)

Chemical References

• ABO Blood-Group System
• Antineoplastic Agents
• Cyclophosphamide
• Busulfan

Topics

• ABO Blood-Group System
• Adolescent
• Antineoplastic Agents (adverse effects)
• Brain Neoplasms (therapy)
• Busulfan (pharmacology)
• Chemical and Drug Induced Liver Injury
• Child
• Child, Preschool
• Cyclophosphamide (pharmacology)
• Female
• Follow-Up Studies
• Hematopoietic Stem Cell Transplantation
• Hepatic Veno-Occlusive Disease (chemically induced, therapy)
• Humans
• Infant
• Liver Diseases (therapy)
• Male
• Multivariate Analysis
• Neuroblastoma (therapy)
• Platelet Transfusion (methods)
• Proportional Hazards Models
• Risk Factors
• Time Factors
• Transplantation Conditioning