Complications

Commonly observed complications include the following:

Hepatic failure: Some degree of hepatic dysfunction is observed in all cases of post-HSCT hepatic veno-occlusive disease/sinusoidal obstruction syndrome (VOD/SOS); however, in rare severe cases, overt liver failure may be observed.
Kidney failure: This may be secondary to hepatorenal syndrome, as well as direct injury by the vasculopathy. In patients who have undergone transplantation, numerous frequently used nephrotoxic drugs (eg, vancomycin, amphotericin B, cyclosporine) can result in preexisting renal dysfunction and loss of renal function reserve. Separating the effects of the drugs from the effects of VOD/SOS may be difficult.
Pulmonary failure
Neurologic compromise
Increased risk of infectious complications due to peritoneal drainage and transfer of an immunodeficient patient to intensive care with no laminar air flow units
Severe consumptive coagulopathy with an increased risk for thrombosis and bleeding

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Author

James L Harper, MD Associate Professor, Department of Pediatrics, Division of Hematology/Oncology and Bone Marrow Transplantation, Associate Chairman for Education, Department of Pediatrics, University of Nebraska Medical Center; Associate Clinical Professor, Department of Pediatrics, Creighton University School of Medicine; Director, Continuing Medical Education, Children's Memorial Hospital; Pediatric Director, Nebraska Regional Hemophilia Treatment Center

James L Harper, MD is a member of the following medical societies: American Society of Pediatric Hematology/Oncology, American Federation for Clinical Research, Council on Medical Student Education in Pediatrics, Hemophilia and Thrombosis Research Society, American Academy of Pediatrics, American Association for Cancer Research, American Society of Hematology

Disclosure: Nothing to disclose.

Coauthor(s)

Selim Corbacioglu, MD Professor of Pediatrics, Chair of Pediatric Hematology, Oncology and Stem Cell Transplantation, Children's Hospital Regensburg, University of Regensburg, Germany

Selim Corbacioglu, MD is a member of the following medical societies: American Association for Cancer Research, American Society of Hematology, European Hematology Association, European Society for Blood and Marrow Transplantation

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Steven K Bergstrom, MD Department of Pediatrics, Division of Hematology-Oncology, Kaiser Permanente Medical Center of Oakland

Steven K Bergstrom, MD is a member of the following medical societies: Alpha Omega Alpha, Children's Oncology Group, American Society of Clinical Oncology, International Society for Experimental Hematology, American Society of Hematology, American Society of Pediatric Hematology/Oncology

Disclosure: Nothing to disclose.

Chief Editor

Jennifer Reikes Willert, MD Associate Clinical Professor, Department of Pediatrics, Division of Pediatric Hematology/Oncology, Section of Stem Cell Transplantation, Stanford University Medical Center, Lucile Packard Children's Hospital

Jennifer Reikes Willert, MD is a member of the following medical societies: American Academy of Pediatrics, American Society for Blood and Marrow Transplantation, American Society of Hematology, American Society of Pediatric Hematology/Oncology, Children's Oncology Group

Disclosure: Nothing to disclose.

Additional Contributors

Stephan A Grupp, MD, PhD Director, Stem Cell Biology Program, Department of Pediatrics, Division of Oncology, Children's Hospital of Philadelphia; Associate Professor of Pediatrics, University of Pennsylvania School of Medicine

Stephan A Grupp, MD, PhD is a member of the following medical societies: American Association for Cancer Research, Society for Pediatric Research, American Society for Blood and Marrow Transplantation, American Society of Hematology, American Society of Pediatric Hematology/Oncology

Disclosure: Nothing to disclose.

Sections Veno-occlusive Hepatic Disease (Sinusoidal Obstruction Syndrome)
Overview
Presentation
DDx
Workup
Treatment
Medication
Follow-up
Tables
References

Criteria	Mild	Moderate	Severe	Very Severe (Multi-Organ Dysfunction/Failure)
Time since first clinical manifestations	> 7 days	5-7 days	≤4 days	Any time
Bilirubin	2 to < 3 mg/dL 34 to < 51 μmol/L	3 to < 5 mg/dL 51 to < 85 μmol/L	5 to < 8 mg/dL 85 to < 136 μmol/L or doubling of bilirubin within 48 hr	≥8 mg/dL ≥136 μmol/L
Transaminases	≤2 x normal	> 2 to 5 x normal	> 5 to 8 x normal	> 8 x normal
Weight increase	< 5%	5% to < 10%	5% to < 10%	≥10%
Kidney function	< 1.2 x baseline	1.2 to < 1.5 x baseline at transplant	1.5 to < 2 x baseline at transplant	≥2 x baseline at transplant or other signs of multi-organ dysfunction/failure

Veno-occlusive Hepatic Disease (Sinusoidal Obstruction Syndrome) Follow-up

Complications

References

Tables

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