What are the guideline sources, guidelines and references for Hepatic veno-occlusive disease ?
Guideline sources The following summarized guidelines for the evaluation and management of hepatic veno-occlusive disease are prepared by our editorial team based on guidelines from the European Association for the Study of the Liver (EASL 2016) and the British Society for Haematology (BSH/BSBMT 2013). 1 2 Calculator Pathway Calculator Baltimore criteria for diagnosis o Hepatic veno-occlusive disease Seattle cr Diagnosis and management Guidelines 1. Screening and diagnosis Clinical presentation: suspect VOD in patients in whom liver disease occurs in the context of prior HSCT, chemotherapy for cancer, or immunosuppression for solid organ transplantation or IBD. B https://web.pathway.md/diseases/recsc7DxcVPDZdf0T 1/4 6/24/23, 12:41 PM Hepatic veno-occlusive disease Pathway Diagnostic criteria: use the modified Seattle or Baltimore criteria to establish the diagnosis of VOD. A Risk factors: assess patients for risk factors for VOD, and address these risk factors prior to HSCT. A 2. Diagnostic investigations Ultrasound: obtain an abdominal ultrasound in patients with suspected VOD, to assist in the exclusion of other disease. B Plasminogen activator inhibitor 1 levels: consider avoiding routine measurement of plasminogen activator inhibitor 1 levels in the evaluation for VOD. D 3. Diagnostic procedures Liver biopsy: As per EASL 2016 guidelines, obtain a transjugular liver biopsy and measurement of portal venous pressures in patients who do not meet clinical criteria of sinusoidal obstruction syndrome, or when other diagnoses have to be excluded. A As per BCSH 2013 guidelines, obtain a transjugular liver biopsy for patients in whom the diagnosis of VOD is unclear, and there is a need to exclude other diagnoses. B 4. Medical management Supportive care: provide supportive care for the treatment of complications of established VOD. B Defibrotide: administer defibrotide for the treatment of VOD in adults and children. B Methylprednisolone: consider administering methylprednisolone for the treatment of VOD, while taking into account the potential risks of infection. C Fluid balance: ensure judicious fluid balance management in patients with VOD. B Tissue plasminogen activator: avoid tPA for the treatment of VOD, due to the associated risk of hemorrhage. D N-acetylcysteine: avoid routine use of N-acetylcysteine in the treatment of VOD, due to lack of efficacy. D 5. Preventative measures Defibrotide: https://web.pathway.md/diseases/recsc7DxcVPDZdf0T 2/4 6/24/23, 12:41 PM Hepatic veno-occlusive disease Pathway As per EASL 2016 guidelines, administer defibrotide to prevent VOD in patients undergoing HSCT. B As per BSH 2013 guidelines, consider administering a course of defibrotide (6.25 mg/kg IV QID) to prevent VOD in adults undergoing allo-SCT who meet 1 of the following criteria: preexisting hepatic disease second myeloablative transplant allogeneic transplant for leukemia beyond second relapse conditioning with busulfan-containing regimens prior treatment with gemtuzumab ozogamicin diagnosis of primary hemophagocytic lymphohistiocytosis adrenoleucodystrophy or osteopetrosis. C Prostaglandin E1: avoid using prostaglandin E1 in the prophylaxis of VOD, due to lack of efficacy and toxicity. D Pentoxifylline: avoid using pentoxifylline for the prophylaxis of VOD due to lack of efficacy. D Ursodeoxycholic acid: consider administering UDCA as an option for the prophylaxis of VOD. C Anticoagulants: consider avoiding unfractionated or LMWH to prevent VOD, due to the risk of increased toxicity. D 6. Follow-up and surveillance Indications for specialist referral: obtain early consultation with critical care and hepatology specialists in patients with VOD, and consider other treatment options including TIPS or liver transplantation. B References 1. European Association for the Study of the Liver. EASL Clinical Practice Guidelines: Vascular diseases of the liver. J Hepatol. 2016 Jan;64 1 179 202. Open 2. Dignan FL, Wynn RF, Hadzic N et al. BCSH/BSBMT guideline: diagnosis and management of veno- occlusive disease (sinusoidal obstruction syndrome) following haematopoietic stem cell transplantation. Br J Haematol. 2013 Nov;163 4 444 57. Open 3. Chien-Chang Lee, Hsiu-Hao Chang, Meng-Yao Lu et al. The incidence and risk factors of hepatic veno- occlusive disease after hematopoietic stem cell transplantation in Taiwan. Ann Hematol. 2019 Mar;98 3 745 752. Open 4. Zhun Cao, Kathleen F Villa, Craig B Lipkin et al. Burden of illness associated with sinusoidal obstruction syndrome/veno-occlusive disease in patients with hematopoietic stem cell transplantation. J Med Econ. 2017 Aug;20 8 871 883. Open https://web.pathway.md/diseases/recsc7DxcVPDZdf0T 3/4 6/24/23, 12:41 PM Hepatic veno-occlusive disease Pathway 5. Jason A Coppell, Paul G Richardson, Robert Soiffer et al. Hepatic veno-occlusive disease following stem cell transplantation: incidence, clinical course, and outcome. Biol Blood Marrow Transplant. 2010 Feb;16 2 157 68. Open https://web.pathway.md/diseases/recsc7DxcVPDZdf0T 4/4