Veno-occlusive disease

Synonyms and Keywords: VOD, sinuosoidal obstruction syndrome

Overview
Veno-occlusive disease (VOD) is a disease of the liver in which the veins in the liver are obstructed or blocked. VOD is a complication that occurs in up to 25% of bone marrow transplantations, and may also occur after ingestion of certain plant alkaloids.

Pathophysiology
VOD is also known as sinuosoidal obstruction syndrome due to obstruction of the venous system. Following bone marrow transplantation, VOD has been hypothesized to be due to injury to the hepatic venous endothelium from the conditioning regimen.

Prognosis
When associated with bone marrow transplant, VOD is fatal in over 30% of cases. Cases due to plant alkaloids often have a longer and more unpredictable course.

Symptoms

 * Weight gain
 * Right upper quadrant pain due to hepatomegaly
 * Abdominal swelling due to ascites

Abdominal Examination

 * Tender hepatomegaly
 * Ascites

Laboratory Studies

 * Increased bilirubin
 * Renal failure may be present

Treatment
Treatment for VOD is primarily supportive. In the BMT setting, defibrotide is an investigational treatment that may be promising. Defibrotide is a polydeoxyribonucleotide; its mechanism of benefit in VOD is unclear, but has been attributed to its antithromboitc properties.

External link

 * American Society of Hematology education book discussion of VOD