VENO-OCCLUSIVE DISEASE AFTER BONE MARROW TRANSPLANTATION. PREVALENCE, PROGNOSIS, AND PREDISPOSING FACTORS. AN EXPERIENCE BASED ON 127 TRANSPLANT PATIENTS.

289 M.-F. Saint-Marc Girardin~ C. Douvin~ C. Cordonnier~ P. Avonsp E.S. Zafrani~ J.-P. Vernant and D. Dhumeaux D~partement d'H~patologie, INSERM U-99 and Unit~ de Greffe de Moelle, HBpital Henri Mondor, 94010 Cr~teil, France.

Veno-occlusive disease of the l iver (VOD) is a well recognized complication of bone marrow transplantation (BMT), but has rarely been documented from a large series of transplant patients. In this work, the prevalence, the prognosis, and the predisposing factors of VOD were studied from 127 consecutive patients who underwent BMT for malignant disease between 1978 and 1984. Conditioning regimen prior to BMT consisted of high dose chemotherapy and total body irradiation. The diagnosis of VOD was based on cr i ter ia previously defined (1). VOD was found in 17 of the 127 patients (13%), within one month after transplantation. Death occurred in 12 out of the 17 patients with VOD (71%) and was direct ly due to VOD in 7. Among the 9 factors investigated (age, sex, diagnosis for which BMT was indicated, previous chemo- therapy, existence of relapse at transplantation, conditioning regimen, preexisting l iver disease, serum ALAT and ASAT values before BMT), univariate analysis showed that only two parameters were signif icantly correlated with an increased incidence of VOD: serum ASAT befo- re BMT and sex. Estimated relative risk (95% confidence interval) of developing VOD for abnormal pretransplant ASAT alone, for females alone, and for the association of both fac- tors, were of 2.45 (1.20-5.02), 2.92 (2.01-4.25) and 3.33 (1.58-7.02), respectively.

This study shows that VOD may occur in more than 10% of patients with BMT and is frequent- ly fatal . I t confirms previous results (1) suggesting that abnormal pretransplant ASAT is a predisposing factor. I t indicates that female sex (perhaps because of systematically prescri- bed progestogens or oestroprogestogens) is an additional predictor and that the association of these two factors could markedly increase the risk of VOD.

(1) McDonald G.B. at al. Hepatology 1984; 4: 116-122.

290

IGA DEPOSITION IN LIVER TISSUE DURING HALOTHANE EXPOSURE MIMICS THE PATTERN TYPI- CAL OF ALCOHOLIC LIVER DISEASE (ALD). M. Salvagnini, S. Spagnolo, u. iv~arcines, B. Mazzucato~ R. Naccarato. Cattedra di Gastroenterologia, Ist i tuto di Medicina Interna. Universit~ di Padova.

IgA deposition in l iver tissue has been reported as a typical marker of alcoholic l iver disea se. No data are, however, available on IgA deposition in other types of toxic exposure. We studied 14 non-drinkers (M/F=5/9) who underwent cholecystectomy under Halothane anasthesia for uncomplicated cholelithiasis without biochemical and histological signs of l iver damage (Group A) and compared them with 47 patients with alcoholic l iver disease, who were devided into three Groups. Group B consisted of 18 subjects (M/F=9/9) with compensated alcoholic cirrhosis; Group C, 15 (M/F=I2/2) with chronic alcoholic hepatitis; and D, 15 (M/F=14/l) with fatty l iver or f ibrosis. Group A had intraoperative l iver biopsies while the other Groups had percutaneous liver biopsies. IgA, IgG and IgM deposition was assayed using immunoperoxidase in deparaffini- zed sections (Histoset, Ortho System). RESULTS: continuous sinusoidal and pericellular posi t iv i ty for IgA was found in 85.7% of Group A patients, in 66.6% of Group B, 66.2% of Group C and 80% of Group D; IgG posi t iv i ty ranged from 28.5% (Group C) to 46.6% (Group D). IgM deposition was found in only one Group A patient and in two Group B patients. CONCLUSION: l) The pattern of Ig oeposi~ion in patients exposed to Halothane anesthesia is similar to that observed in ALD; 2) These findings suggest that Ig deposition is not related to the severity or chronicity of l iver damage, but is an unspecific consequence of hepatotoxic agents.

$323