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Stem Cell Transplantation for Hematologic Malignancies pp 297–314Cite as

Hepatic Veno-Occlusive Disease

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Part of the book series: Contemporary Hematology ((CH))

Abstract

The clinical syndrome of hepatic veno-occlusive disease (VOD) after hematopoietic stem cell transplantation (HSCT) is characterized by liver enlargement and pain, fluid retention, weight gain, and jaundice (1–3). Its onset is typically by d +30 after stem cell transplantation (SCT), although later onset has been described (4). As the diagnosis is based on clinical criteria, the incidence reported and severity seen is variable, ranging from 10% to 60%, and may be influenced by differences in conditioning regimens and patient characteristics (5,6). Prognosis is also variable. Mild disease is defined by no apparent adverse effect from liver dysfunction with complete resolution of symptoms and signs. Moderate disease is characterized by adverse effects of liver dysfunction requiring therapy such as diuresis for fluid retention and analgesia for right upper-quadrant pain but with eventual complete resolution. The majority of patients fall into the mild to moderate category, but a significant fraction of VOD is severe, and although occasional patients may recover, most are essentially incurable, with a fatality rate approaching 100% (5,7). VOD is considered to be part of the spectrum of nonmyeloid organ injury syndromes that can occur after high-dose therapy and SCT, which include idiopathic pneumonitis, diffuse alveolar hemorrhage, thrombotic microangiopathy, and capillary-leak syndrome. There is a growing body of evidence indicating that early injury to vascular endothelium either directly by the conditioning regimen or indirectly through the production of certain cytokines is a common denominator of these events (8–10). This may explain why VOD is more common in allogeneic SCT (a11oSCT), where there is a greater degree of cytokine dysregulation and immune dysfunction, as compared to autologous SCT (autoSCT) (5).

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  1. Paul G. Richardson MD
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  1. Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA

    Robert J. Soiffer MD

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Richardson, P.G. (2004). Hepatic Veno-Occlusive Disease. In: Soiffer, R.J. (eds) Stem Cell Transplantation for Hematologic Malignancies. Contemporary Hematology. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-59259-733-8_13

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  • DOI: https://doi.org/10.1007/978-1-59259-733-8_13

  • Publisher Name: Humana Press, Totowa, NJ

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