Sinusoidal obstruction syndrome primary prevention

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Husnain Shaukat, M.D [2]

Overview

Primary preventive measures of sinusoidal obstruction syndrome include minimizing risks related to the transplant process such as the source of the graft (allogeneic greater than autologous), choice of chemotherapy and use of antimicrobials. The exposure to the hepatotoxic agents should be minimized and preexisting liver diseases should be managed. The prophylaxis for graft vs host disease should be considered.

Primary Prevention

Hepatic sinusoidal obstruction syndrome (SOS) is a complication of allogeneic and autologous hematopoietic cell transplantation (HCT). The measures for the primary prevention of sinusoidal obstruction syndrome include:[1][2]

  • Minimizing risks related to the transplant process such as younger age < 7 years, source of the graft (allogeneic greater than autologous), choice of chemotherapy and use of antimicrobials.
  • The exposure to the hepatotoxic agents should be minimized. This includes alcohol, over-the-counter medications (nonsteroidal anti-inflammatory drugs, overuse of acetaminophen), herbal remedies and prescribed drugs with hepatotoxic side effects.
  • Treatment of preexisting liver disease.
  • The prophylaxis for graft vs host disease should be considered.

References

  1. Dignan FL, Wynn RF, Hadzic N, Karani J, Quaglia A, Pagliuca A, Veys P, Potter MN (2013). "BCSH/BSBMT guideline: diagnosis and management of veno-occlusive disease (sinusoidal obstruction syndrome) following haematopoietic stem cell transplantation". Br. J. Haematol. 163 (4): 444–57. doi:10.1111/bjh.12558. PMID 24102514.
  2. Ruutu T, Eriksson B, Remes K, Juvonen E, Volin L, Remberger M, Parkkali T, Hägglund H, Ringdén O (2002). "Ursodeoxycholic acid for the prevention of hepatic complications in allogeneic stem cell transplantation". Blood. 100 (6): 1977–83. doi:10.1182/blood-2001-12-0159. PMID 12200355.



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