Prevention and treatment of hepatic venocclusive disease after high-dose cytoreductive therapy

Venocclusive disease of the liver (VOD) is one of the most common and serio us complications following stem cell transplantation. High-dose chemotherap y or chemoradiotherapy injures the structures of Zone 3 of the liver acinus and produces the clinical syndrome of hepatomegaly or right upper quadrant pain, jaundice, and fluid retention. VOD occurs in up to 54 % of stem cell transplant recipients and is fatal in 25-50 % of them. While the clinical signs of VOD usually manifest during the first post-transplant week, late p resentation can occur. The purpose of this review is to discuss the manifes tations and pathophysiology of VOD and the options for prevention and treat ment.