Sinusoidal obstruction syndrome natural history, complications and prognosis

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

Patients with a mild or moderate form of sinusoidal obstruction syndrome require no specific therapy and can be managed with supportive care alone.The mild and moderate form of sinusoidal obstruction syndrome has a good prognosis. If left untreated, the severe form of sinusoidal obstruction syndrome is characterized by high mortality and progression to multiorgan failure.

• Sinusoidal obstruction syndrome is a common complication in patients with hematopoietic stem cell transplant.
• If left untreated, the severe form of sinusoidal obstruction syndrome is characterized by high mortality and progression to multiorgan failure.^[1]

Complications that can develop as a result of sinusoidal obstruction syndrome are:^[2][3][4][5]

• Portal hypertension
• Hepatic encephalopathy
• Variceal hemorrhage
• Hepatorenal syndrome
• Hepatic decompensation
• Bacterial peritonitis especially the following paracentesis

• Sinusoidal obstruction syndrome is considered mild, moderate or severe based on the clinical course during the first three months of hematopoietic cell transplantation.^[6]
• Patients with a mild or moderate form of sinusoidal obstruction syndrome require no specific therapy and can be managed with supportive care alone and progressively resolves over a 2- to 3-week period.^[7]
• Patients with the severe sinusoidal obstruction syndrome have a high rate of mortality and can progress to multiorgan failure.^[8]

Morbidity and mortality is associated with following factors:^{[9][10][11][12]}

• Younger age in children
• Older age in adults
• Poor performance status
• Pre-existing hepatic dysfunction
• History of pancreatitis
• Advanced malignancy
• Acute leukemia
• Presence of acute graft-versus-host disease
• Allogeneic HCT
• Unrelated donor HCT
• Mismatched donor
• Prior abdominal irradiation
• High dose cytoreductive therapy
• Total body irradiation

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