Division of Pediatric Hematology, Oncology and Bone Marrow Transplant, Nationwide Children's Hospital, Columbus, Ohio; Department of Pediatrics, The Ohio State University, Columbus, Ohio.
Division of Pediatric Hematology, Oncology and Bone Marrow Transplant, Nationwide Children's Hospital, Columbus, Ohio.
Biol Blood Marrow Transplant. 2018 Feb;24(2):337-342. doi: 10.1016/j.bbmt.2017.10.038. Epub 2017 Nov 8.
Hematopoietic cell transplant (HCT) is associated with a proinflammatory, procoagulant environment that places recipients at increased risk of venous thromboembolism (VTE). Although the incidence of VTE in adult HCT recipients has been extensively studied, similar data for children are lacking. We conducted a multicenter retrospective study to analyze the prevalence of VTE and associated risk factors in a large cohort of patients who underwent HCT at tertiary care US children's hospitals. The Pediatric Health Information System database, a large administrative database that contains clinical and resource utilization data from 49 freestanding children's hospitals in the United States, was used to extract data. International Classification of Diseases, Ninth Revision, Clinical Modification codes were used to identify HCT recipients, VTE events, post-HCT complications, and associated risk factors up to 1 year post-transplant. Data on patients who received HCT from January 2010 through September 2014 were collected. A total of 4158 unique patients mean ± standard deviation age at transplant admit, 8.8 ± 6.5 years; range, birth to 33.4 years) were identified. After HCT 290 subjects (6.9%) developed VTE. VTE prevalence was greater in patients aged ≥ 13 versus <13 years (8.54% versus 6.33%; P = .01) and in recipients of allogeneic versus autologous grafts (7.7% versus 5%; P ≤ .01). VTE was associated with prolonged median duration of hospitalization (81 versus 54 days; P ≤.01) and increased 1-year mortality (13.9% versus 5.9%; P ≤ .01). Infections and presence of any graft-versus-host disease (GVHD) were significantly associated with VTE occurrence in recipients of allogenic grafts. Prevalence of VTE in patients who underwent HCT at pediatric tertiary care hospitals is about 7%. Age ≥ 13 years and allogeneic grafts were significant pre-HCT VTE risk factors, with GVHD and infections seen more frequently in patients with VTE.
造血细胞移植（HCT）会引起促炎和促凝环境，使受者发生静脉血栓栓塞症（VTE）的风险增加。虽然成人 HCT 受者的 VTE 发生率已得到广泛研究，但儿童的类似数据尚缺乏。我们进行了一项多中心回顾性研究，以分析在美国三级儿童保健医院接受 HCT 的大型患者队列中的 VTE 发生率和相关危险因素。使用大型行政数据库——儿科健康信息系统数据库，从美国 49 家独立儿童医院提取数据，该数据库包含临床和资源利用数据。使用国际疾病分类，第九版临床修订版（ICD-9-CM）代码识别 HCT 受者、VTE 事件、HCT 后并发症以及移植后 1 年内的相关危险因素。收集了 2010 年 1 月至 2014 年 9 月接受 HCT 的患者数据。共确定了 4158 例患者，中位（标准差）移植时年龄为 8.8 ± 6.5 岁（范围：出生至 33.4 岁）。HCT 后 290 例（6.9%）患者发生 VTE。≥ 13 岁与＜13 岁患者的 VTE 发生率（8.54%与 6.33%；P =.01）和异基因与自体移植物受者的 VTE 发生率（7.7%与 5%；P ≤.01）更高。VTE 与中位住院时间延长（81 天与 54 天；P ≤.01）和 1 年死亡率增加（13.9%与 5.9%；P ≤.01）相关。异基因移植物受者中，感染和任何移植物抗宿主病（GVHD）与 VTE 发生显著相关。儿科三级保健医院接受 HCT 的患者 VTE 发生率约为 7%。年龄≥13 岁和异基因移植物是 HCT 前 VTE 的重要危险因素，VTE 患者中更常出现 GVHD 和感染。
