{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T11:12:46Z","timestamp":1789384366074,"version":"build-2803163510"},"reference-count":99,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2013,9,17]],"date-time":"2013-09-17T00:00:00Z","timestamp":1379376000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Br J Haematol"],"published-print":{"date-parts":[[2013,11]]},"abstract":"<jats:title>Summary of Key Recommendations<\/jats:title><jats:sec><jats:title>Diagnosis<\/jats:title><jats:p>\n<jats:list list-type=\"bullet\">\n\n<jats:list-item><jats:p>It is recommended that the diagnosis of veno\u2010occlusive disease (sinusoidal obstruction syndrome) [VOD (SOS)] be based primarily on established clinical criteria (modified Seattle or Baltimore criteria) (1A).<\/jats:p><\/jats:list-item>\n\n<jats:list-item><jats:p>Ultrasound imaging may be helpful in the exclusion of other disorders in patients with suspected VOD (SOS) (1C).<\/jats:p><\/jats:list-item>\n\n<jats:list-item><jats:p>It is recommended that liver biopsy be reserved for patients in whom the diagnosis of VOD (SOS) is unclear and there is a need to exclude other diagnoses (1C).<\/jats:p><\/jats:list-item>\n\n<jats:list-item><jats:p>It is recommended that liver biopsies are undertaken using the transjugular approach in order to reduce the risks associated with the procedure (1C).<\/jats:p><\/jats:list-item>\n\n<jats:list-item><jats:p>It is suggested that the role of plasminogen activator inhibitor 1 levels remains an area for further research but that these levels should not form part of the routine diagnostic work\u2010up for VOD (SOS) at present (2C).<\/jats:p><\/jats:list-item>\n<\/jats:list>\n<\/jats:p><\/jats:sec><jats:sec><jats:title>Risk factors<\/jats:title><jats:p>\n<jats:list list-type=\"bullet\">\n\n<jats:list-item><jats:p>It is recommended that patients are assessed for risk factors for VOD (SOS) and that these risk factors are addressed prior to haematopoietic stem cell transplantation (1A).<\/jats:p><\/jats:list-item>\n<\/jats:list>\n<\/jats:p><\/jats:sec><jats:sec><jats:title>Prophylaxis<\/jats:title><jats:p>\n<jats:list list-type=\"bullet\">\n\n<jats:list-item><jats:p>Defibrotide is recommended at a dose of 6\u00b725\u00a0mg\/kg intravenously four times daily for the prevention of VOD (SOS) in children undergoing allogeneic stem cell transplantation with the following risk factors: pre\u2010existing hepatic disease, second myeloablative transplant, allogeneic transplant for leukaemia beyond second relapse, conditioning with busulfan\u2010containing regimens, prior treatment with gemtuzumab ozogamicin, diagnosis of primary haemophagocytic lymphohistiocytosis, adrenoleucodystrophy or osteopetrosis (1A).<\/jats:p><\/jats:list-item>\n\n<jats:list-item><jats:p>Defibrotide is suggested at a dose of 6\u00b725\u00a0mg\/kg intravenously four times daily for the prevention of VOD (SOS) in adults undergoing allogeneic stem cell transplantation with the following risk factors: pre\u2010existing hepatic disease, second myeloablative transplant, allogeneic transplant for leukaemia beyond second relapse, conditioning with busulfan\u2010containing regimens, prior treatment with gemtuzumab ozogamicin, diagnosis of primary haemophagocytic lymphohistiocytosis, adrenoleucodystrophy or osteopetrosis (2B).<\/jats:p><\/jats:list-item>\n\n<jats:list-item><jats:p>Prostaglandin E1 is not recommended in the prophylaxis of VOD (SOS) due to lack of efficacy and toxicity (1B).<\/jats:p><\/jats:list-item>\n\n<jats:list-item><jats:p>Pentoxifylline is not recommended in the prophylaxis of VOD (SOS) due to lack of efficacy (1A).<\/jats:p><\/jats:list-item>\n\n<jats:list-item><jats:p>Ursodeoxycholic acid is suggested for use in the prophylaxis of VOD (SOS) (2C).<\/jats:p><\/jats:list-item>\n\n<jats:list-item><jats:p>Heparin (unfractionated and low molecular weight) is not suggested for use in the prophylaxis of VOD (SOS) due to the risk of increased toxicity (2B).<\/jats:p><\/jats:list-item>\n\n<jats:list-item><jats:p>Antithrombin is not suggested for the prophylaxis of VOD (SOS) due to lack of efficacy (2B).<\/jats:p><\/jats:list-item>\n<\/jats:list>\n<\/jats:p><\/jats:sec><jats:sec><jats:title>Treatment<\/jats:title><jats:p>\n<jats:list list-type=\"bullet\">\n\n<jats:list-item><jats:p>Defibrotide is recommended in the treatment of VOD (SOS) in adults and children (1B).<\/jats:p><\/jats:list-item>\n\n<jats:list-item><jats:p>Tissue plasminogen activator is not recommended for use in the treatment of VOD (SOS) due to the associated risk of haemorrhage (1B).<\/jats:p><\/jats:list-item>\n\n<jats:list-item><jats:p>N\u2010acetylcysteine is not routinely recommended for use in the treatment of veno\u2010occlusive disease due to lack of efficacy (1A).<\/jats:p><\/jats:list-item>\n\n<jats:list-item><jats:p>Methylprednisolone may be considered for use in the treatment of veno\u2010occlusive disease with the appropriate caveats of caution regarding infection (2C).<\/jats:p><\/jats:list-item>\n\n<jats:list-item><jats:p>Judicious clinical care, particularly in the management of fluid balance, is recommended in the management of VOD (SOS) (1C).<\/jats:p><\/jats:list-item>\n\n<jats:list-item><jats:p>Early discussion with critical care specialists and a specialist hepatology unit is recommended in the management of VOD (SOS) and other treatment options including transjugular intrahepatic portosystemic shunt or hepatic transplantation may be considered (1C).<\/jats:p><\/jats:list-item>\n<\/jats:list>\n<\/jats:p><\/jats:sec><jats:sec><jats:title>Summary<\/jats:title><jats:p>A joint working group established by the Haemato\u2010oncology subgroup of the British Committee for Standards in Haematology (<jats:styled-content style=\"fixed-case\">BCSH<\/jats:styled-content>) and the British Society for Blood and Marrow Transplantation (<jats:styled-content style=\"fixed-case\">BSBMT<\/jats:styled-content>) has reviewed the available literature and made recommendations for the diagnosis and management of veno\u2010occlusive disease of the liver following haematopoietic stem cell transplantation (<jats:styled-content style=\"fixed-case\">HSCT<\/jats:styled-content>). This guideline includes recommendations for both prophylaxis and treatment of the condition and includes recommendations for children and adults undergoing <jats:styled-content style=\"fixed-case\">HSCT<\/jats:styled-content>.<\/jats:p><\/jats:sec>","DOI":"10.1111\/bjh.12558","type":"journal-article","created":{"date-parts":[[2013,10,8]],"date-time":"2013-10-08T15:34:26Z","timestamp":1381246466000},"page":"444-457","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":267,"title":["<scp>BCSH<\/scp>\/<scp>BSBMT<\/scp> guideline: diagnosis and management of veno\u2010occlusive disease (sinusoidal obstruction syndrome) following haematopoietic stem cell transplantation"],"prefix":"10.1111","volume":"163","author":[{"given":"Fiona L.","family":"Dignan","sequence":"first","affiliation":[{"name":"Department of Haematology Central Manchester NHS Foundation Trust Manchester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert F.","family":"Wynn","sequence":"additional","affiliation":[{"name":"Royal Manchester Children's Hospital Manchester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nedim","family":"Hadzic","sequence":"additional","affiliation":[{"name":"Paediatric Liver Service &amp; 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