Kim Kwi Suk, Moon Aree, Kang Hyoung Jin, Shin Hee Young, Choi Young Hee, Kim Hyang Sook, Kim Sang Geon
Kwi Suk Kim, Hyang Sook Kim, Sang Geon Kim, Department of Pharmacy, Seoul National University Hospital, Seoul 03080, South Korea.
World J Transplant. 2016 Jun 24;6(2):403-10. doi: 10.5500/wjt.v6.i2.403.
To analyze the association between plasma bilirubin levels and veno-occlusive disease (VOD) in non-adult patients undergoing hematopoietic stem cell transplantation (HSCT) during cyclosporine therapy.
A total of 123 patients taking cyclosporine were evaluated using an electronic medical system at the Seoul National University Children's Hospital from the years 2004 through 2011. Patients were grouped by age and analyzed for incidence and type of adverse drug reactions (ADRs) including VOD.
The HSCT patients were divided into three age groups: G#1 ≥ 18; 9 ≤ G#2 ≤ 17; and G#3 ≤ 8 years of age). The majority of transplant donor types were cord blood transplantations. Most prevalent ADRs represented acute graft-vs-host disease (aGVHD) and VOD. Although the incidences of aGVHD did not vary among the groups, the higher frequency ratios of VOD in G#3 suggested that an age of 8 or younger is a risk factor for developing VOD in HSCT patients. After cyclosporine therapy, the trough plasma concentrations of cyclosporine were lower in G#3 than in G#1, indicative of its increased clearance. Moreover, in G#3 only, a maximal total bilirubin level (BILmax) of ≥ 1.4 mg/dL correlated with VOD incidence after cyclosporine therapy.
HSCT patients 8 years of age or younger are more at risk for developing VOD, diagnosed as hyperbilirubinemia, tender hepatomegaly, and ascites/weight gain after cyclosporine therapy, which may be represented by a criterion of plasma BILmax being ≥ 1.4 mg/dL, suggestive of more sensitive VOD indication in this age group.
分析接受造血干细胞移植（HSCT）的非成年患者在环孢素治疗期间血浆胆红素水平与静脉闭塞性疾病（VOD）之间的关联。
2004年至2011年期间，在首尔国立大学儿童医院使用电子医疗系统对总共123例服用环孢素的患者进行了评估。患者按年龄分组，并分析包括VOD在内的药物不良反应（ADR）的发生率和类型。
HSCT患者分为三个年龄组：G#1≥18岁；9≤G#2≤17岁；G#3≤8岁）。大多数移植供体类型为脐血移植。最常见的ADR是急性移植物抗宿主病（aGVHD）和VOD。虽然aGVHD的发生率在各组之间没有差异，但G#3组中VOD的频率更高，表明8岁及以下的年龄是HSCT患者发生VOD的危险因素。环孢素治疗后，G#3组中环孢素的谷浓度低于G#1组，表明其清除率增加。此外，仅在G#3组中，最大总胆红素水平（BILmax）≥1.4mg/dL与环孢素治疗后的VOD发生率相关。
8岁及以下的HSCT患者发生VOD的风险更高，VOD在环孢素治疗后被诊断为高胆红素血症、肝肿大压痛和腹水/体重增加，这可能由血浆BILmax≥1.4mg/dL的标准来表示，提示该年龄组中VOD的指示更为敏感。
