StemCell Therapy

Autologous transplantation:patients receive their own stem cells after a course of myeloablative conditioning; about 12,000 are performed each year. Allogeneic transplantation:patients receive stem cells, bone marrow, or cord blood from a matched related or unrelated donor; about 8,000 are performed each year. Myeloablative conditioning:high-dose chemotherapy or total body irradiation given to kill cells in the bone marrow, including cancer cells, to prepare the body to receive healthy, autologous or allogeneic transplantations.

Although blood and marrow transplants can save patients lives, they can also result in numerous complications, including infections, renal failure, and liver complications, such as veno-occlusive disease (VOD). VOD can occur in as high as 70% of patients and is the most common hepatic complication in the immediate post-transplant period. Along with infections and graft-versus-host disease, it is also one of the most common causes of death after transplant.

In her article in the October 2012 issue of the Clinical Journal of Oncology Nursing, Sosa describes VOD and its causes, risk factors, prevention, interventions, and treatment options. Although no U.S. Food and Drug Administration-approved treatments currently exist for VOD, oncology nurses play a key role in early diagnosis and supportive care for patients with this complication.

VOD is not caused by the transplantation itself but rather the myeloablative conditioning regimen leading up to the procedure. Risk factors for VOD are outlined in Figure 1. Weight gain may occur before patients receive the actual transplant. Serum bilirubin often elevates to 2 mg/dl or higher within 610 days after the transplant, followed by edema and ascites. Patients may develop jaundice because of the increased bilirubin levels. If VOD is severe, weight gain and bilirubin levels increase at a faster rate.

Symptoms of VOD are not limited to the liver. Another indicator is increased platelet refractoriness, which may occur even before weight gain and liver enlargement are apparent. In addition, multiorgan failure may occur in severe cases. Serum creatinine may become elevated, resulting in renal failure, so patients may require hemodialysis. Because of fluid retention, patients may develop an enlarged heart, cardiac failure, or pleural effusions. As azotemia and hepatic encephalopathy develop, patients may experience confusion and altered mental status.

The gold standard for VOD diagnosis is histologically through a liver biopsy. However, the test can be dangerous in transplant recipients who are neutropenic or thrombocytopenic. Ultrasound is sometimes used as an alternative, but findings may be vague. Doppler ultrasound, which shows increased arterial resistance, may offer more specific results. Finally, differential diagnosis may be made based on clinical signs and symptoms.

Once VOD is diagnosed, it is classified according to severity.

Because no FDA-approved treatments currently exist for VOD, the nurses emphasis is on preventive measures and supportive care if VOD manifests.

Medications for prevention: When given as a low-dose continuous IV infusion starting before transplantation, heparin reduces the amount of clotting proteins in the hepatic venules. However, studies have not proven that it effectively prevents VOD.

See the article here:
Veno-Occlusive Disease Is the Most Common Hepatic ...

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