Hepatic veno-occlusive disease

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Hepatic veno-occlusive disease
Classification and external resources
Specialty gastroenterology
ICD-10 K76.5
OMIM 235550
DiseasesDB 34365
eMedicine ped/2396
MeSH D006504
GeneReviews

Hepatic veno-occlusive disease or veno-occlusive disease (VOD) is a condition in which some of the small veins in the liver are obstructed. It is a complication of high-dose chemotherapy given before a bone marrow transplant (BMT) and is marked by weight gain due to fluid retention, increased liver size, and raised levels of bilirubin in the blood.[1] The name sinusoidal obstruction syndrome is now preferred if VOD happens as a result of chemotherapy or bone marrow transplantation.[1][2]

Apart from chemotherapy, VOD may also occur after ingestion of certain plant alkaloids such as pyrrolizidine alkaloids (in some herbal teas),[1] and has been described as part of a rare hereditary disease called hepatic venoocclusive disease with immunodeficiency (which results from mutations in the gene coding for a protein called SP110).[3]

Signs and symptoms[edit]

Features of VOD include weight gain, tender hepatomegaly, ascites, and jaundice; it often is associated with renal failure.[4]

Pathophysiology[edit]

In the BMT setting, VOD is felt to be due to injury to the hepatic venous endothelium from the conditioning regimen.

Toxic agents causing veno-occlusive disease include plants as well as the medication cyclophosphamide.

Diagnosis[edit]

Hepatic doppler ultrasound is typically utilized to confirm or suggest the diagnosis. Most common findings on liver doppler ultrasound include increased phasicity of portal veins with eventual development of portal flow reversal. The liver is usually enlarged but maintained normal echogenicity. A liver biopsy is required for a definitive diagnosis.[citation needed]

Treatment[edit]

Treatment generally includes supportive care including pain management and possibly diuretics.[5] In the those severe disease due to a bone marrow transplant, defibrotide is a proposed treatment.[6] It has been approved for use in severe cases in Europe and the United States.[7][8] A placebo controlled trial, however, has not been done as of 2016.[5]

Prognosis[edit]

Mild disease has a risk of death of about 10% while moderate disease has a risk of death of 20%.[5] When it occurs as a result of bone marrow transplant and multiorgan failure is present, the risk of death is greater than 80%.[6]

History[edit]

The first report on veno-occlusive disease, in 1920, was as a result of senecio poisoning in South Africa.[9] Subsequent reports were mostly in Jamaicans who had consumed herbal teas.[1] With the advent of bone marrow transplanation, most later reported cases have been in those undergoing treatment for leukemia.[1]

See also[edit]

References[edit]

  1. ^ a b c d e Helmy A (January 2006). "Review article: updates in the pathogenesis and therapy of hepatic sinusoidal obstruction syndrome". Aliment. Pharmacol. Ther. 23 (1): 11–25. PMID 16393276. doi:10.1111/j.1365-2036.2006.02742.x. 
  2. ^ DeLeve LD, Shulman HM, McDonald GB (February 2002). "Toxic injury to hepatic sinusoids: sinusoidal obstruction syndrome (veno-occlusive disease)". Semin. Liver Dis. 22 (1): 27–42. PMID 11928077. doi:10.1055/s-2002-23204. 
  3. ^ Roscioli T, Cliffe ST, Bloch DB (June 2006). "Mutations in the gene encoding the PML nuclear body protein Sp110 are associated with immunodeficiency and hepatic veno-occlusive disease". Nat. Genet. 38 (6): 620–2. PMID 16648851. doi:10.1038/ng1780. 
  4. ^ RESERVED, INSERM US14 -- ALL RIGHTS. "Orphanet: Hepatic veno occlusive disease". www.orpha.net. Retrieved 2016-12-26. 
  5. ^ a b c Dalle, JH; Giralt, SA (March 2016). "Hepatic Veno-Occlusive Disease after Hematopoietic Stem Cell Transplantation: Risk Factors and Stratification, Prophylaxis, and Treatment.". Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation. 22 (3): 400–9. PMID 26431626. doi:10.1016/j.bbmt.2015.09.024. 
  6. ^ a b Fulgenzi, A; Ferrero, ME (2016). "Defibrotide in the treatment of hepatic veno-occlusive disease.". Hepatic medicine : evidence and research. 8: 105–113. PMID 27843363. doi:10.2147/HMER.S79243. 
  7. ^ Keating, GM (December 2014). "Defibrotide: a review of its use in severe hepatic veno-occlusive disease following haematopoietic stem cell transplantation.". Clinical drug investigation. 34 (12): 895–904. PMID 25351934. doi:10.1007/s40261-014-0242-x. 
  8. ^ "Press Announcements - FDA approves first treatment for rare disease in patients who receive stem cell transplant from blood or bone marrow". www.fda.gov. Retrieved 18 July 2017. 
  9. ^ Willmot, F; Robertson, George (1920). "Senecio disease, or cirrhosis of the liver due to senecio poisoning". The Lancet. 196 (5069): 848. doi:10.1016/S0140-6736(01)00020-4. 

Further reading[edit]