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i3 Health

Optimizing Nursing Management of Hepatic Veno-Occlusive Disease

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Overview / Abstract:


Veno-occlusive disease (VOD), also known as sinusoidal obstruction syndrome, is a potentially life-threatening complication of hematopoietic stem cell transplant (HSCT), characterized by weight gain, fluid retention with ascites, tender hepatomegaly, and jaundice. The toxicity is believed to result from damage to hepatic sinusoidal endothelial cells, which causes obstructed sinusoidal flow that leads to liver dysfunction, multiorgan failure, and death. The incidence of VOD following HSCT is unclear due to variations in diagnosis but has been reported to be as high as 60%. Specific groups such as children, patients with previous hepatic injury, or those undergoing allogeneic HSCT (as opposed to autologous HSCT) are at increased risk, especially when the conditioning regimen contains chemotherapy, irradiation, or busulfan. In patients with severe cases, the mortality rate has been estimated to be greater than 80%. In addition, VOD has been associated with increased health care system resource utilization and costs (estimated to be $8,988 for mild cases and $41,703 for severe cases). Efforts to control the toxicity must therefore focus on primary prevention and strategies to monitor patients for signs and symptoms so that timely and effective treatment can be initiated.


Oncology nurse practitioners, clinical nurse specialists, nurses, and other health care professionals involved in the management of hepatic veno-occlusive disease.


Upon completion of this activity, participants should be able to:

1. Describe the pathophysiology of VOD
2. Assess the risk for VOD in cancer patients undergoing hematopoietic stem cell transplant
3. Evaluate evidence-based supportive care plans to mitigate VOD in pediatric and adult patients with cancer


Nov 01, 2018


Nurse Practitioner , Nursing CNE, Physician CME, Physician Assistant CME


Online, Webinar / Webcast / Video

Credits / Hours




Presenters / Authors / Faculty

Phyllis McKiernan, APN, MSN, OCN
Advanced Practice Nurse
John Theurer Cancer Center

Michelle N. Rickard DNP, CPNP-AC, CHPPN, BMTCN, CPON
Assistant Professor, College of Nursing
University of Tennessee Health Science Center

Sponsors / Supporters / Grant Providers

This activity is supported by an independent educational grant from Jazz Pharmaceuticals.

Keywords / Search Terms

i3 Health i3 Health i3 Health, veno-occlusive disease, VOD, sinusoidal obstruction syndrome, SOS, supportive care, CE, free CE, enduring CE, oncology Free CE CME enduring CE CME Free CE CME

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