Toxic Injury to Hepatic Sinusoids: Sinusoidal Obstruction Syndrome (Veno-Occlusive Disease)

Laurie D. DeLeve; Howard M. Shulman; George B. McDonald

doi:10.1055/s-2002-23204

Seminars in Liver Disease, Table of Contents

Semin Liver Dis 2002; 22(1): 027-042
DOI: 10.1055/s-2002-23204

Toxic Injury to Hepatic Sinusoids: Sinusoidal Obstruction Syndrome (Veno-Occlusive Disease)

Laurie D. DeLeve¹ , Howard M. Shulman² , George B. McDonald³

¹USC Research Center for Liver Diseases and Division of Gastrointestinal and Liver Diseases, University of Southern California Keck School of Medicine, Los Angeles, California
²Department of Pathology, Fred Hutchinson Cancer Research Center and the University of Washington School of Medicine, Seattle, Washington
³Gastroenterology/Hepatology Section, Fred Hutchinson Cancer Research Center and the University of Washington School of Medicine, Seattle, Washington

Abstract

ABSTRACT

The term veno-occlusive disease of the liver refers to a form of toxic liver injury characterized clinically by the development of hepatomegaly, ascites, and jaundice, and histologically by diffuse damage in the centrilobular zone of the liver. The cardinal histologic features of this injury are marked sinusoidal fibrosis, necrosis of pericentral hepatocytes, and narrowing and eventual fibrosis of central veins. Recent studies suggest that the primary site of the toxic injury is sinusoidal endothelial cells, followed by a series of biologic processes that lead to circulatory compromise of centrilobular hepatocytes, fibrosis, and obstruction of liver blood flow. Thus we propose a more appropriate name for this form of liver injury-sinusoidal obstruction syndrome. This review encompasses historical perspectives, clinical manifestations of sinusoidal obstruction syndrome in the setting of hematopoietic cell transplantation, histologic features of centrilobular injury, and a discussion of the pathophysiology of sinusoidal injury, based on both animal and clinical investigations.

KEYWORD

Sinusoidal obstruction - veno-occlusive disease - toxic liver injury

Full Text

References

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