THE VENOOCCLUSIVE DISEASE OF THE LIVER

Background and Objective. The veno-occlusive disease of the liver (VOD ) is a disorder caused by the non-thrombotic occlusion of the central veins of hepatic lobules. The clinical features are similar to those o f intrahepatic portal hypertension (unexplained weight gain, ascites, painful hepatomegaly, jaundice). In the past, this disease was rather infrequent and was linked to the absorption of toxic agents, liver irr adiation or chemotherapy. However, the intensification of treatment pr otocols before hematopoietic stem cell transplants has considerably in creased its incidence. The strategies used for its prevention and trea tment remain limited in efficacy. The present review was undertaken in order to assess progress in the diagnosis and management of this seve re complication in stem cell transplantation. Information Sources. The method used for preparing this review was an examination of 250 relev ant articles or abstracts published in journals covered by Medline(R). State of Art. Despite the progress made toward the understanding of i ts physiopathology and the identification of its risk factors, VOD is still one of the leading causes of morbidity and mortality during the first two months post-BMT, and therefore often constitutes a limitatio n for the further increment of the dose of antineoplastic drugs. This may be explained by the difficulty in making an early diagnosis of thi s problem, at a time when therapeutic intervention may be more effecti ve, and, on the other hand, the lack of a well-established prevention and treatment approach for patients with VOD. Perspectives and Conclus ions. New diagnostic procedures, such as laparoscopic liver biopsy, an d new therapeutic approaches, such as transjugular intrahepatic portos ystemic shunting (TIPS) or defibrotide, are now being evaluated. Howev er, additional studies will be needed to determine the most appropriat e therapy for each VOD patient depending on the severity of the diseas e. (C) 1997, Ferrata Storti Foundation.