The occurrence of hepatic veno-occlusive disease (VOD) has been reported in up to
60% of patients following stem cell transplantation (SCT), with incidence varying
widely between studies depending on the type of transplant, conditioning regimen,
and criteria used to make the diagnosis. Severe VOD is characterized by high mortality
and progression to multiorgan failure (MOF); however, there is no consensus on how
to evaluate severity. This review and analysis of published reports attempts to clarify
these issues by calculating the overall mean incidence of VOD and mortality from severe
VOD, examining the effect of changes in SCT practice on the incidence of VOD over
time, and discussing the methods used to evaluate severity. Across 135 studies performed
between 1979 and October 2007, the overall mean incidence of VOD was 13.7% (95% confidence
interval [CI]=13.3%-14.1%). The mean incidence of VOD was significantly lower between
1979-1994 than between 1994-2007 (11.5% [95% CI, 10.9%-12.1%] vs 14.6% [95% CI, 14.0%-15.2%];
P <.05). The mortality rate from severe VOD was 84.3% (95% CI, 79.6%-88.9%); most
of these patients had MOF, which also was the most frequent cause of death. Thus,
VOD is less common than early reports suggested, but the current incidence appears
to be relatively stable despite recent advances in SCT, including the advent of reduced-intensity
conditioning. The evolution of MOF in the setting of VOD after SCT can be considered
a reliable indication of severity and a predictor of poor outcome.