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hepatic veno-occlusive disease; sinusoidal obstruction syndrome
Etiology:
- cytotoxic agents
a) complicates 5-15% of allogeneic stem-cell transplants
b) cyclophosphamide
c) other chemotherapeutic agents
d) herbal teas
1] pennroyal
2] germander
3] chaprral leaf
4] comfry
5] jin bu huan
- risk factors
a) advanced age
b) prior liver injury
c) infusion of mismatched or unrelated donor stem cells
- sirolimus to prevent graft-versus-host disease (GVHD).
Pathology:
- damage of hepatocytes & the hepatic sinusoidal endothelium
Management:
1) usually treated with antifibrinolytic agent defibrotide, with only modest success
2) liver transplantation in refractory cases
General
veno-occlusive disease
liver disease
References
- Cutler C et al
Sirolimus is associated with veno-occlusive disease of the
liver after myeloablative allogeneic stem cell transplantation.
Blood 2008 Dec 1; 112:4425.
PMID: 18776081