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Diagnosis of veno-occlusive disease/sinusoidal obstruction syndrome of the liver: problems of interpretation

Bone Marrow Transplantation volume 51, pages 1633–1635 (2016)Cite this article

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Veno-occlusive disease of the liver (VOD), also called sinusoidal obstruction syndrome, is a potentially serious complication of hematopoietic stem cell transplantation which is thought to be mainly caused by the conditioning treatment preceding the transplantation. The reported incidences of VOD have varied widely. In recent reviews the present incidence has been stated to be up to 10–15%.1, 2 The differences in the incidences may be due to different patient materials and transplantation methods or to differences in the application and interpretation of diagnostic criteria. The Seattle criteria,3 which have been later modified,4 or the Baltimore criteria5 are commonly used to establish the diagnosis. The diagnosis is based on a combination of clinical criteria. However, as the criteria are not specific for VOD and no pathognomonic findings exist, it is recommended that the diagnosis of VOD should be made only when there are no other conditions explaining the clinical findings.1, 2 More than one condition causing liver problems, including VOD, may be present at the same time leaving the opportunity for subjective interpretation that could essentially affect the perceived incidence of this disorder. Along with the improving opportunities for prophylaxis and treatment of VOD, it is important to have a correct estimate of its incidence. We evaluated the differential diagnostic component of the VOD diagnosis in our single-center material.

The hospital notes of 300 consecutive adult patients treated with allogeneic stem cell transplantation between March 2011 and February 2015 at Helsinki University Hospital were retrospectively reviewed. All but one had a malignant hematological disease (Table 1). One hundred and thirty-five patients (45%) received conventional myeloablative conditioning, TBI or busulfan with cyclophosphamide. One hundred and fifty-one patients were given treosulfan in a myeloablative or reduced dose with fludarabine, 7 received reduced dose busulfan with fludarabine, and 7 another regimen. Of the donors 75% were unrelated, and 77% of the grafts were from peripheral blood. All patients received ursodeoxycholic acid (UDCA) prophylaxis.6 GvHD prophylaxis consisted of cyclosporine A and three doses of methotrexate. In sibling transplantations methylprednisolone was included in the prophylaxis if the conditioning was TBI or high-dose busulfan with cyclophosphamide.7 Ten patients received mycophenolate mofetil instead of methotrexate. ATG was given in transplantations from an unrelated donor.

Table 1 Patient and transplantation characteristics
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Authors and Affiliations

  1. Helsinki University Hospital, Comprehensive Cancer Center, Stem Cell Transplantation Unit, Helsinki, Finland

    L Volin, R Niittyvuopio, J Heiskanen, V Lindström, A Nihtinen, L Sahlstedt & T Ruutu

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  1. L Volin
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  2. R Niittyvuopio
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Correspondence to L Volin.

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Volin, L., Niittyvuopio, R., Heiskanen, J. et al. Diagnosis of veno-occlusive disease/sinusoidal obstruction syndrome of the liver: problems of interpretation. Bone Marrow Transplant 51, 1633–1635 (2016). https://doi.org/10.1038/bmt.2016.237

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