Use of CRRT-CVVH in a hemato-oncological ICU in patients treated with defibrotide for veno-occlusive disease in patients after allogeneic hematopoetic stem cell transplantation: single-center experience
© BioMed Central Ltd. 2010
Published: 1 March 2010
Complex care in the hemato-oncological ICU sometimes requires the use of CRRT. As the hemato-oncological patients have some specifications we retrospectively followed up the results of our effort in patients with acute renal failure due to veno-occlusive disease (VOD) after allogeneic hematopoietic stem cell transplantation. VOD is one of the most severe early complications in this type of patients and its mortality is high.
From 1 January 2007 to 30 October 2009 we performed 94 procedures (one procedure = 24 hours) in 15 patients with VOD and acute renal oligo-anuric failure. As a standard in our ICU we perform CVVH with post dilution on a Fresenius Multifiltrate machine. The key drug for the treatment of VOD is defibrotide and the patients were severely thrombocytopenic, we have not used any anticoagulation in the CVVH set. The dose of defibrotide ranged from 10 to 20 mg/kg/day according to the severity of thrombocytopenia and eventually hemorrhagic symptoms. Blood count, acid-base balance and biochemistry were monitored at least twice daily. The thrombocytopenia was corrected with the donor platelets and the platelet level was sustained at 20 × 109l.
The introduction of CVVH in all 15 patients dramatically helped to overcome the severe part of VOD until the defibrotide helped to restore the right function of vascular endothelium. None of the 15 patients died from VOD as a cause of death. Surprisingly, the median patency of the CVVH tubing set was 46 hours despite no anticoagulation in the tubing set. Defibrotide is efficient in preventing coagulation in the tubing set. No serious hemorrhagic events were observed. The fluent maintenance of fluid balance, the removal of waste products of metabolism and the maintenance of acid-base balance were very important for the patient in the critical point of advanced VOD.
CVVH is an integral part of intensive care in hemato-oncology and the use of this therapeutic modality in patients with VOD with acute renal failure can significantly improve the results of our therapeutic efforts.