Pre-transplant Liver Disorders: Post-transplant Impact on Developing Venocclusive Disease/Sinusoidal Obstruction Syndrome and Other Hepatic Problems
The identification of pre-transplant liver disorders is important to avoid post-transplant development of venocclusive disease/sinusoidal obstruction syndrome (VOD/SOS) or hepatic decompensation. The pre-transplant disorders which predispose an increased risk of death are inflammatory conditions like viral hepatitis, fibrosing liver disorders such as cirrhosis or nonalcoholic steatohepatitis (NASH), myeloproliferative disorders, and prior history of liver toxicity after exposure to certain oncology drugs. Recognition of these disorders will affect the eligibility for transplant or may lead to a change in the pre-transplant conditioning regimen. The pathophysiology of VOD/SOS is presented. The clinical and histologic gold standards for diagnosing VOD/SOS are discussed, since occluded venules may be clinically silent.
KeywordsVenocclusive disease (VOD) Sinusoidal occlusive syndrome (SOS) Risk factors for VOD/SOS Pre-transplant liver disorders Hepatic iron overload pre-hematopoietic stem cell transplant Transvenous liver biopsy Pathophysiology of mylotarg hepatotoxicity Pathophysiology of VOD/SOS
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