Veno-occlusive Disease

Therapy for veno-occlusive disease of the liver (VOD) occurring after bone marrow transplantation should be directed at those with moderate or severe disease who will not recover on their own. Thrombolytic therapy may have a role in severe VOD as long as there is no renal or lung impairment. However, the risk of bleeding complications, including the risk of cerebral hemorrhage, must be considered in these patients. Defibrotide has shown promise for treatment of severe VOD but is not yet widely available in the United States. Therapy directed at reducing portal hypertension such as transjugular intrahepatic portosystemic shunts helps reduce ascites but has no effect on mortality. Liver transplantation has been reported but should be considered only in patients with severe liver failure who would have a good outcome in the absence of liver disease or have undergone bone marrow transplantation for benign disease. The most important advances in VOD has been in the prevention of this syndrome by recognizing the risk factors for it and changes in conditioning regimens before bone marrow transplantation.