Rapidly progressive pulmonary venoocclusive disease in young women taking oral contraceptives

Department of Pathology, University of California San Francisco, San Francisco, CA 94143-0102, USA.
The Journal of heart and lung transplantation: the official publication of the International Society for Heart Transplantation (Impact Factor: 6.65). 09/2012; 31(9):1031-6. DOI: 10.1016/j.healun.2012.05.007
Source: PubMed

ABSTRACT Pulmonary venoocclusive disease (PVOD) is a rare cause of pulmonary hypertension characterized by a progressive clinical course and poor outcomes if not treated by early lung transplantation. The pathogenesis of PVOD remains poorly understood. We report PVOD that developed in 2 young women soon after the initiation of oral contraceptives (OCs). The first patient is a 14-year-old girl, with no medical history, who started taking an OC 3 weeks before the onset of symptoms. The second patient is an 18-year-old girl, diagnosed 2 years previously with systemic lupus erythematosus and lupus anticoagulant, who started taking an OC 4 months before the onset of symptoms. Both patients required lung transplantation. Radiographic and histopathologic findings in both patients showed features of PVOD. Only 1 prior patient with PVOD and a handful of unclassified patients with pulmonary hypertension in association with OCs have been documented. The importance of PVOD as the basis of pulmonary hypertension in patients with connective tissue disease has been recently proposed, as well as the role of thrombogenesis, in the development of PVOD. The temporal sequence in these 2 patients suggests the thrombogenic action of OCs may contribute to the development of PVOD, with or without underlying connective tissue disease.

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    ABSTRACT: Pulmonary veno-occlusive disease (PVOD) is a rare form of pulmonary hypertension which occurs in 0.1-0.2 people per million. Its etiology is still poorly understood but is related to several risk factors. The histopathology of PVOD is characterized by intimal fibrosis narrowing or the occlusion of small pulmonary veins or venules. A definitive diagnosis requires a surgical biopsy, which is a risky procedure. Thus, the diagnosis must be based on high clinical suspicion and the results of various diagnostic tests, mainly high-resolution computed tomography, pulmonary function tests, bronchoalveolar lavage, and right heart catheterization. The definitive treatment is limited to lung transplantation. Several pulmonary arterial hypertension-specific agents may cause pulmonary edema in PVOD. However, the cautious use of such medications in selected patients, and surgical or mechanical supports, may successfully bridge patients to transplantation. Given the scant knowledge regarding this entity, future studies with a focus on elucidating the etiology and establishing the optimal treatment are required, as is further development in diagnosis. © 2014 S. Karger AG, Basel.
    Respiration 05/2014; 88(2). DOI:10.1159/000359973 · 2.59 Impact Factor
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    ABSTRACT: Introduction: Pulmonary veno-occlusive disease (PVOD) is an uncommon cause of pulmonary arterial hypertension (PAH). However, unlike PAH, treatment options for PVOD are usually quite limited. The impact of the lung allocation score on access to transplantation for PVOD patients, and the clinical course of these patients, have not been well-described. Methods: Patients with a diagnosis of PVOD and PAH registered on the United Network for Organ Sharing wait list for transplantation from May 4, 2005-May 3, 2013 were included. Lung transplantation was the primary outcome measure. Multivariable analyses were performed to determine the odds of dying or receiving a lung transplant after listing. Survival was compared using Kaplan-Meier and competing risks methods. Results: Of 12,251 patients listed for lung transplantation, 49 with PVOD and 647 with PAH were identified. There were no significant differences in the lung allocation score between PVOD and PAH patients at listing, transplant, or wait list removal for death/ too sick for transplant. By 6 months, 22.6% of PVOD patients had been removed from the wait list due to death, compared to 11.0% of PAH patients (Chi square p=0.03). PVOD patients who died or were considered too sick for transplant were removed from the waiting list sooner after listing (22 vs. 105 days, p=0.08). There was no difference in the proportion of PVOD and PAH patients transplanted (50.0% vs. 47.6%, p=0.60). Conclusion: In the lung allocation score era, PVOD patients may be at higher risk for death while on the transplant waiting list. After wait list registration, close monitoring for disease progression is advised.
    10/2014; 11(9). DOI:10.1513/AnnalsATS.201408-354OC