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Usefulness of liver stiffness measurement in predicting hepatic veno-occlusive disease development in patients who undergo HSCT

Bone Marrow Transplantation volume 52, pages 494–497 (2017)Cite this article

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Hepatic veno-occlusive disease (VOD), or sinusoidal obstructive syndrome (SOS), is a clinical syndrome characterized by hepatomegaly, ascites, weight gain and jaundice, which can develop more frequently in the first 30 days after hematopoietic stem cell transplantation (HSCT).1, 2 Its incidence, although influenced by diagnostic criteria, has been estimated to be 13.7% (range 0–62.3%) and, in untreated hepatic severe VOD/SOS, it is associated with >80% mortality.3 In this syndrome, sinusoidal endothelial cells and hepatocytes in zone 3 of the hepatic acinus are damaged by toxic metabolites generated during the conditioning regimen.4 The classic VOD pathway develops by the narrowing of the sinusoids, embolization of endothelial cells and increased clot formation, leading to obstruction of the sinusoids, subendothelial and centro-acinar fibrosis and then to portal-central fibrosis resulting in post-sinusoidal portal hypertension, which dominates the clinical picture.5

The diagnosis of VOD is primarily based on established clinical criteria (modified Seattle or Baltimore criteria);6, 7, 8, 9 ultrasound imaging may be helpful in the exclusion of other disorders in patients with suspected VOD. Liver biopsy should be reserved for patients in whom the diagnosis of VOD is unclear and other diagnoses need to be excluded.10

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Authors and Affiliations

  1. Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy

    A Colecchia, G Marasco, F Ravaioli & D Festi

  2. Pediatric Oncology and Hematology Unit, University of Bologna Sant’Orsola-Malpighi Hospital, Bologna, Italy

    K Kleinschmidt, R Masetti, A Prete & A Pession

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  1. A Colecchia
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Correspondence to A Colecchia.

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Colecchia, A., Marasco, G., Ravaioli, F. et al. Usefulness of liver stiffness measurement in predicting hepatic veno-occlusive disease development in patients who undergo HSCT. Bone Marrow Transplant 52, 494–497 (2017). https://doi.org/10.1038/bmt.2016.320

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