Sinusoidal obstruction syndrome/veno-occlusive disease: current situation and perspectives-a position statement from the European Society for Blood and Marrow Transplantation (EBMT)

Abstract

Sinusoidal obstruction syndrome or veno-occlusive disease (SOS/VOD) is a potentially life-threatening complication of hematopoietic SCT (HSCT). This review aims to highlight, on behalf of the European Society for Blood and Marrow Transplantation, the current knowledge on SOS/VOD pathophysiology, risk factors, diagnosis and treatments. Our perspectives on SOS/VOD are (i) to accurately identify its risk factors; (ii) to define new criteria for its diagnosis; (iii) to search for SOS/VOD biomarkers and (iv) to propose prospective studies evaluating SOS/VOD prevention and treatment in adults and children.

Figure 1

Schematic representation of the hepatic acinus. In sinusoidal obstruction syndrome, obstruction of the hepatic sinusoids occurs in the zone 3 of the hepatic acinus.

Figure 2

Sinusoidal obstruction syndrome pathogenesis. (a) Normal hepatic sinusoid; (b) sinusoidal endothelial cells damaged during conditioning round up favoring the appearance of gaps in the sinusoidal barrier; (c) RBCs, leucocytes and cellular debris penetrate into the space of Disse detaching the endothelial lining; (d) the sloughed sinusoidal lining cells embolize downstream and obstruct the sinusoidal flow (sinusoidal obstruction syndrome). Adapted from 'The role of the endothelium in the short-term complications of hematopoietic SCT' by E Carreras and M Diaz-Ricart.