title: Hepatic veno-occlusive disease following stem cell transplantation: incidence, clinical course, and outcome.
abstract: The occurrence of hepatic veno-occlusive disease (VOD) has been reported in up to 60% of patients following stem cell transplantation (SCT), with incidence varying widely between studies depending on the type of transplant, conditioning regimen, and criteria used to make the diagnosis. Severe VOD is characterized by high mortality and progression to multiorgan failure (MOF); however, there is no consensus on how to evaluate severity. This review and analysis of published reports attempts to clarify these issues by calculating the overall mean incidence of VOD and mortality from severe VOD, examining the effect of changes in SCT practice on the incidence of VOD over time, and discussing the methods used to evaluate severity. Across 135 studies performed between 1979 and October 2007, the overall mean incidence of VOD was 13.7% (95% confidence interval [CI]=13.3%-14.1%). The mean incidence of VOD was significantly lower between 1979-1994 than between 1994-2007 (11.5% [95% CI, 10.9%-12.1%] vs 14.6% [95% CI, 14.0%-15.2%]; P <.05). The mortality rate from severe VOD was 84.3% (95% CI, 79.6%-88.9%); most of these patients had MOF, which also was the most frequent cause of death. Thus, VOD is less common than early reports suggested, but the current incidence appears to be relatively stable despite recent advances in SCT, including the advent of reduced-intensity conditioning. The evolution of MOF in the setting of VOD after SCT can be considered a reliable indication of severity and a predictor of poor outcome.
authors.affiliation: Department of Haematology, Royal Devon and Exeter Hospital, Exeter, UK. jason.coppell@rdeft.nhs.uk
authors.forename: Jason A
authors.initials: JA
authors.lastname: Coppell
authors.forename: Paul G
authors.initials: PG
authors.lastname: Richardson
authors.forename: Robert
authors.initials: R
authors.lastname: Soiffer
authors.forename: Paul L
authors.initials: PL
authors.lastname: Martin
authors.forename: Nancy A
authors.initials: NA
authors.lastname: Kernan
authors.forename: Allen
authors.initials: A
authors.lastname: Chen
authors.forename: Eva
authors.initials: E
authors.lastname: Guinan
authors.forename: Georgia
authors.initials: G
authors.lastname: Vogelsang
authors.forename: Amrita
authors.initials: A
authors.lastname: Krishnan
authors.forename: Sergio
authors.initials: S
authors.lastname: Giralt
authors.forename: Carolyn
authors.initials: C
authors.lastname: Revta
authors.forename: Nicole A
authors.initials: NA
authors.lastname: Carreau
authors.forename: Massimo
authors.initials: M
authors.lastname: Iacobelli
authors.forename: Enric
authors.initials: E
authors.lastname: Carreras
authors.forename: Tapani
authors.initials: T
authors.lastname: Ruutu
authors.forename: Tiziano
authors.initials: T
authors.lastname: Barbui
authors.forename: Joseph H
authors.initials: JH
authors.lastname: Antin
authors.forename: Dietger
authors.initials: D
authors.lastname: Niederwieser
mesh_terms: D018450:Disease Progression; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects* / Q000379:methods; D006504:Hepatic Veno-Occlusive Disease / Q000150:complications* / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D006530:Hepatorenal Syndrome / Q000209:etiology; D006801:Humans; D015994:Incidence; D009102:Multiple Organ Failure / Q000209:etiology; D012720:Severity of Illness Index; D019172:Transplantation Conditioning / Q000639:trends; D016896:Treatment Outcome