Noninvasive Evaluation of Hepatic Veno-Occlusive Disease after Hematopoietic Stem Cell Transplantation by Doppler Ultrasound

Hepatic veno-occlusive disease (VOD) is severe complication of hematopoietic stem cell transplantation (HSCT). The purpose of this study was to diagnose VOD using ultrasound (US), and distinguish between VOD and graft-versus-host disease (GVHD). From June 2008 to February 2011, 88 subjects underwent US before and after HSCT. VOD was diagnosed based on Baltimoa and/or Modified Seatle criteria, and GVHD hepatic biopsy. US findings were graded based on the following findings: ten findings in B mode (hepatomegaly (right and left lobe), splenomegaly, gall bladder wall thickness, diameter of each hepatic vein, portal vein and para-umbilical vein, and existence of ascites) and seven findings in Doppler (direction and mean velocity of portal vein, each hepatic vein's wave form, appearance of blood flow signal in para-umbilical vein and resistive index of hepatic artery). VOD score, up to seventeen, was calculated by adding B mode and Doppler findings. Statistical analysis were performed by t-test and Tukey's test (P<0.05) Seven patients developed VOD (8.0%) and four GVHD (4.5%), Mean scores of pre HSCT, VOD and GVHD were 1.4, 8.1 and 3.7, respectively. There were significant differences among them (P<0.001). Significant difference was found between pre HSCT score in VOD 4.6 and in subjects that have not developed VOD 1.3 (P<0.001). VOD score might be useful to diagnose VOD, and possible criteria in the differentiation of GVHD.