Venocclusive disease (VOD) of the liver, a fibrous obliteration of small hepatic venules, can be caused by chemoradiation therapy. We reviewed 255 consecutive patients undergoing bone marrow transplantation for malignancy during 1978 to 1980 in order to determine the incidence of VOD and the predisposing factors. Fifty-three of 255 patients met our criteria for VOD, for an incidence of 21%. Multivariate analysis showed that the most significant risk factors for VOD were age over 15, an underlying malignancy other than acute lymphocytic leukemia and hepatitis prior to transplantation. Patients with hepatitis had a 3.4-fold risk of developing VOD, as compared to patients with normal SGOT values (p = 0.0004). Hepatitis in this setting is probably of non-A, non-B viral etiology and represents a relative contraindication to marrow transplantation because of enhanced toxicity from conditioning chemoradiotherapy.
Venocclusive disease (VOD) of the liver refers to narrowing or fibrous obliteration of terminal hepatic venules and small sublobular veins (1, 2). Depending on the extent of the venous occlusion, the resulting obstruction of blood flow leads to liver enlargement, ascites, hepatocellular necrosis, and encephalopathy. We and others have reported that the primary cause of VOD after bone marrow transplantation was chemotherapy and radiation therapy used to prepare patients for transplantation (2- 7, Vowels, M. et al., Royal College of Pathologists of Australia, 1979; p. 306, Abstract). Statistical analysis of 204 autopsied marrow recipients identified several additional predisposing factors for the development of VOD (2). These were: leukemia as a diagnosis (as opposed to aplastic anemia); having a second transplant; and having an "abnormal liver" prior to transplantation (2). There