Veno-occlusive disease of the liver complicating bone marrow transplantation

Veno-occlusive disease (VOD) of the liver is a major complication of bone marrow transplantation. The clinical features are those of intrahepatic portal hypertension and while the reported frequency varies considerably, severe disease is readily identifiable and is associated with a high mortality. The single most important risk factor for the development of VOD is an elevated ALT prior to transplantation. The incidence of VOD may be reduced by prophylactic administration of anticoagulant or antiplatelet drugs and established disease can be treated by thrombolytic therapy with tissue plasminogen activator. These observations suggest that endothelial damage and thrombin generation are fundamental to the disease process. Protection of the endothelium from toxic damage and inhibition of thrombin generation are potential targets for preventing VOD.