Veno-occlusive Disease
Sanjay Kakar, MD
Key Facts
Etiology/Pathogenesis
Stem cell transplantation and high-dose chemotherapy
Sinusoidal endothelial cell injury is important initial event
Clinical Issues
Hyperbilirubinemia, weight gain, and painful hepatomegaly
Attenuated or reverse flow in portal vein on Doppler ultrasound
Microscopic Pathology
Subendothelial edema, red cell extravasation, fibrin deposition in sinusoids and central vein
Zone 3 sinusoidal dilatation and hepatocellular necrosis
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
Veno-occlusive disease (VOD)
Synonyms
Sinusoidal obstruction syndrome (SOS)
ETIOLOGY/PATHOGENESIS
Etiology
Stem cell transplantation and high-dose chemotherapy are most common causes
Risk Factors
Older age and poor performance status
HLA disparity in allogeneic stem cell transplant
Preexisting liver dysfunction
Prior abdominal radiation
Pretransplant use of acyclovir or vancomycin
High-dose busulphan and cyclophosphamide therapy
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