Hepatic Veno-Occlusive Disease after Hematopoietic Stem Cell Transplantation: Novel Insights to Pathogenesis, Current Status of Treatment, and Future Directions

Abstract

INTRODUCTION flow reversal and hepatorenal syndrome, leading toMOF and Hepatic veno-occlusive disease (VOD), also known as sinusoidal obstruction syndrome, is a potentially lifethreatening complication after hematopoietic stem cell transplantation (HSCT). VOD affects both adult and pediatric populations alike, with a higher incidence in the allogeneic setting [1]. Disease onset is typically within the first 30 days after HSCT [1], although later occurrence has been reported [2]. It is characterized by clinical features such as hepatomegaly, jaundice, weight gain, and ascites [3,4]. VOD is reported to occur in 8% to 14% of patients after HSCT [3], although incidence rates may be as high as 60% in higher-risk patients (such as those with underlying liver disease and certain specific drug exposures, including gemtuzumab, ozogamicin, and sirolimus) and depending on the diagnostic criteria used [3,4]. Severe VOD (sVOD) is typically associated with multiorgan failure (MOF) and high mortality rates (>80%) [3,4]. Even among patients with moderate VOD, the mortality rate is still estimated at approximately 20% [5].