Veno occlusive disease: Update on clinical management

Table 1 Risk factors for the development of VOD

1	Pre existing liver disease (hepatitis C, previous fibrosis, hypertransaminasemia)
2	Previous exposure to a myeloablative regimen
3	Past history of HSOS
4	Use of myeloablative regimen
5	High dose of total body irradiation
6	Use of cyclophosphamide containing regimes
7	Administration of cyclophosphamide after busulfan
8	Fixed dose of Busulfan
9	Use of oral rather than ev Busulfan
10	Late timing of SCT in patients with leukaemia
11	Carriers of haemocromathosis C282Y allele

Table 2 Diagnostic criteria of veno occlusive disease after SCT Seattle criteria

Seattle criteria
At least two of the three following criteria: within the first month after stem cell transplantation (STC):
1	Jaundice
2	Hepatomegaly and right upper quadrant pain
3	Ascites and/or unexplained weight gain
Baltimore criteria
Elevated total serum bilirubin (≥ 2 mg/dL) before d 21 after SCT and two of the following three criteria:
1	Tender hepatomegaly
2	Weight gain ≥ 5% from baseline
3	Ascites
Modified Seattle criteria
Occurrence of two of the following events within 20 d of SCT:
1	Hyperbilirubinaemia (≥ 2 mg/dL)
2	Hepatomegaly or right upper quadrant pain of liver origin
3	Unexplained weight gain (> 2% of baseline bodyweight) because of fluid accumulation

Table 3 Classification of severity of veno occlusive disease after bone marrow transplantation according to weight increase (%), bilirubin concentration peak, presence of peripheral edema and ascites[1] (mean ± SD)

	Mild	Moderate	Severe
Weight gain (% increase)	7.0 ± 3.5	10.1 ± 5.3	15.5 ± 9.2
Maximum bilirubin (mg/dL)	4.7 ± 2.9	7.9 ± 6.6	26.6 ± 15.2
Percentage with peripheral edema	23	70	85
Percentage with ascites	5	16	48
Day 100 mortality (all causes) (%)	3	20	98

Table 4 Outcome of patients undergoing TIPS for veno occlusive disease

Autho	Patients	Etiology	Severity VOD	Improvement portal hypertension	Early mortality (< 1 m)	Late mortality (> 1 m)
Azoulay (2000)	10	BMT	Severe	10/10	5/10	4/5
Fried (1996)	6	BMT	Severe	6/6	4/6	1/2
Annarolo (2004)	1	BMT	Severe	yes	Alive 3 yr f-up
Zenz (2001)	3	BMT	Severe/modetate	3/3	3/3	-
Azoulay (1998)	1	KTx	Severe	yes	Alive 36 mo f-up
Shen (1996)	1	Irradiation pelvis	Moderate	yes	Alive 5 mo f-up
Leny (1996)	1	BMT	Severe	yes	yes	-
De la Rubia (1996)	1	BMT	Moderate	yes	Alive 9 mo f-up
Smith (1996)	1	BMT	Severe	yes	yes	-
Meacher (1999)	1	BMT	Severe	-	yes	yes
Lerut (1999)	1 among series	LT	-	yes	-	-
Sebagh (1999)	1 among series	LT	-	-	re-OLT