Veno-Occlusive Disease (VOD)
Occurs because of damage to endothelial cells in hepatic venules and sinusoids resulting in obstruction to hepatic venous blood flow.
Complicates 2%-50% of HSCT.
Risk factors for VOD include:
- Busulfan / cyclophosphamide conditioning regimen
- Prior stem cell transplant
- Elevated liver enzymes going into transplant.
- Use of a drug called Gemtuzumab (used to treat AML) in previous 3 months.
- Hepatic radiation (as part of total body irradiation).
- Bacterial or viral infection involving the liver.
Clinical presentation includes :
- Tender RUQ hepatomegaly
- Ascites
- Edema
- Weight gain
- Conjugated hyperbilirubinemia.
Severity can be from mild to life-threatening.
Treatment is supportive and includes maintaining intravascular fluid volume to maintain hepatic and renal perfusion.
Defibrotide is a new agent that shows promise in treating VOD.
