Summary

Hepatic veno-occlusive disease (VOD) is a severe complicationafter hematopoietic stem cell transplantation (HSCT). Recentstudies, mainly in adults receiving HSCT, have identified an increasein the plasminogen activator inhibitor-1 (PAI-1) as a possiblemarker of VOD.To confirm this finding, the fibrinolytic, coagulationand liver function parameters were assayed before andweekly for 1 month after 61 HSCT performed in 53 consecutivechildren.Non-VOD patients had a slight increase in t-PA antigen,fibrinogen and P-selectin levels, as well as a mildly longer aPTTand a drop in antithrombin after HSCT.The 6 children withVOD(9.84%) had an early and significant increase in PAI-1 antigen and activity (p<0.0001), t-PA antigen (p<0.0001) and D-dimer(p<0.01) levels, and a decrease in plasminogen, a 2-antiplasminand PT emerged 2( ± 1) days before the clinical diagnosis ofVODby comparison with mean post-HSCT values in the non-VODpatients.Significant differences were also detected for these parametersand antithrombin levels between non-VOD and VODpatients soon after the clinical onset ofVOD, whereas the rise inbilirubin levels became significant only later on. In conclusion,variations in fibrinolytic test findings after HSCT, and PAI-1 inparticular, may facilitate the early diagnosis of VOD in pediatricpatients after HSCT.