Veno-occlusive Disease
Sanjay Kakar, MD
Key Facts
Etiology/Pathogenesis
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Stem cell transplantation and high-dose chemotherapy
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Sinusoidal endothelial cell injury is important initial event
Clinical Issues
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Hyperbilirubinemia, weight gain, and painful hepatomegaly
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Attenuated or reverse flow in portal vein on Doppler ultrasound
Microscopic Pathology
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Subendothelial edema, red cell extravasation, fibrin deposition in sinusoids and central vein
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Zone 3 sinusoidal dilatation and hepatocellular necrosis
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Venular obliteration and widespread fibrosis
Complete obliteration of the central vein  accompanied by centrizonal sinusoidal congestion is seen in veno-occlusive disease. |
Endothelial swelling with subendothelial edema and fibrosis  lead to partial occlusion of the lumen of a small hepatic vein in veno-occlusive disease. |
TERMINOLOGY
Abbreviations
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Veno-occlusive disease (VOD)
Synonyms
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Sinusoidal obstruction syndrome (SOS)
ETIOLOGY/PATHOGENESIS
Etiology
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Stem cell transplantation and high-dose chemotherapy are most common causes
Risk Factors
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Older age and poor performance status
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HLA disparity in allogeneic stem cell transplant
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Preexisting liver dysfunction
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Prior abdominal radiation
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Pretransplant use of acyclovir or vancomycin
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High-dose busulphan and cyclophosphamide therapy
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