Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation 2017 11 08() pii S1083-8791(17)30807-8
Hematopoietic cell transplant (HCT) is associated with a pro-inflammatory, pro-coagulant environment which places recipients at increased risk of venous thromboembolism (VTE). While 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 (PHIS) database, a large administrative database that contains clinical and resource utilization data from 49 freestanding children’s hospitals in the US, was used to extract data. International Classification of Diseases, Ninth Revision, and Clinical Modification (ICD-9-CM) codes were used to identify HCT recipients, VTE events, post-HCT complications, and associated risk factors up to one year post-transplant. Data on patients who received HCT from January 2010 through September 2014 was collected.
4158 unique patients with mean (±SD) age at transplant admit being 8.8 (±6.5) years (range: birth to 33.4 years) were identified. Following HCT, 290 subjects (6.9%) developed VTE. VTE prevalence was greater in patients aged ≥13 vs. <13 years (8.54 vs. 6.33 %; p=0.01), recipients of allogeneic vs. autologous grafts (7.7% vs. 5%; p ≤ 0.01). VTE was associated with prolonged median duration of hospitalization (81 vs. 54 days p ≤0.01) and increased one-year mortality (13.9 vs. 5.9% p ≤0.01). Infections and presence of any graft versus host disease (GvHD) were significantly associated with VTE occurrence in recipients of allogenic grafts. CONCLUSIONS
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.