Veno-occlusive disease

Abstract

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.

Enfermedad veno-oclusiva hepática, colitis ulcerosa idiopática y trombosis portal: Comunicación de un caso clínico

“…También se ha considerado como indicación de trasplante hepáti-co 2 . El tratamiento de la EVOH propiamente tal es complejo y están en estudio marcadores que ayuden a un diagnóstico precoz, junto a un manejo de mayor eficacia antitrombótica con el uso de tPA, antitrombina III o defibrotide 18 . Se ha ensayado el manejo profiláctico con ácido ursodeoxicólico, heparina continua y de bajo peso molecular en los pacientes que requieren trasplante alogénico de médula ósea 19,20 .…”

Alternative source of inflow to the donor hepatic arteries

“…Willner7 suggested that liver transplantation should be carried out in patients with SOS who underwent bone marrow transplantation for benign disease. MacQuillan and Mutimer8 questioned the benefits of liver transplantation in this population.…”