Veno-occlusive disease (VOD), or sinusoidal obstruction syndrome, is a serious complication following hematopoietic stem cell transplantation, involving liver vein blockage and significant morbidity if not managed well. The complexity of VOD necessitates ongoing advancements in treatment strategies for better patient outcomes.
Preventive Measures
Preventive strategies for VOD focus on minimizing risk. Tailoring conditioning regimens to individual risk profiles is crucial, as some chemotherapeutic agents like busulfan and cyclophosphamide increase VOD incidence. Recent studies highlight the importance of dose adjustment and using less toxic alternatives. Prophylactic pharmacological agents like ursodeoxycholic acid, recommended for its hepatoprotective properties, significantly decrease VOD occurrence. Defibrotide, approved for high-risk patients, reduces VOD incidence by up to 40%.
Nutritional support and lifestyle modifications also aid prevention. Adequate hydration and a balanced diet help maintain liver function during transplantation. Regular liver function tests and dietary interventions are recommended for comprehensive prevention.
Pharmacological Interventions
Pharmacological management of VOD focuses on symptom mitigation and addressing underlying causes. Defibrotide, with antithrombotic and anti-inflammatory properties, has improved survival rates in severe VOD cases. A multicenter trial reported a survival rate of approximately 38% with defibrotide treatment.
Exploration of other agents like N-acetylcysteine (NAC) suggests potential hepatoprotective benefits due to its antioxidant properties. Preliminary data show improved liver function markers, though more trials are needed. Anticoagulants like low-molecular-weight heparin (LMWH) have been considered, but their use requires careful risk assessment due to bleeding risks.
Curative Interventions
Curative interventions aim to reverse VOD and restore liver function, requiring personalized treatment plans. Liver transplantation remains a definitive option for severe, treatment-refractory cases, with documented survival rates exceeding 70% post-transplantation.
Supportive care, including advanced hemodynamic monitoring and nutritional support, complements direct interventions. Techniques like transjugular intrahepatic portosystemic shunt (TIPS) alleviate portal hypertension, reducing liver congestion and aiding recovery. A study in the Journal of Hepatology shows TIPS can significantly improve liver function and patient survival.