Seattle and Baltimore criteria for VOD (SOS)
Diagnosis and severity of veno-occlusive disease of the liver (sinusoidal obstruction syndrome)
1. Establish diagnosis (Seattle or Baltimore criteria)
| Modified Seattle criteria | Baltimore criteria |
|---|---|
At least two of the following, occurring within 20d of transplantation:
| Serum bilirubin > 34 umol/L (> 2mg/dL) within 21d of transplantation AND at least two of the following:
|
2. Determine severity (Seattle criteria)
| Mild | No adverse effects of liver disease, AND No medications required for diuresis or hepatic pain, AND All symptoms, signs and laboratory features reversible |
| Moderate | Adverse effects of liver disease present, AND Sodium restriction or diuretics required, OR Medication for hepatic pain required, AND All symptoms, signs and laboratory features reversible |
| Severe | Adverse effects of liver disease present, AND Symptoms, signs or laboratory features not resolved by day +100, OR Death |
Hepatic Veno-occlusive disease (VOD) or Sinusoidal Obstruction Syndrome (SOS) is a syndrome comprising weight gain, ascites, painful hepatomegaly and jaundice, and occurs in around 14% of patients following allogeneic stem cell transplantation (range 0 – 62%, depending on the series).1 Risk factors include the use of myeloablative conditioning, an stem cell source other than a matched sibling donor, pre-existing liver disease, and poor performance status.2
Two diagnostic systems are in common use, and are shown here: the modified Seattle criteria,3 and the Baltimore criteria.4 The Baltimore criteria are more stringent, with an absolute requirement for hyperbilirubinaemia.
The severity of VOD/SOS can be classified retrospectively using Seattle criteria, as shown in the lower table.2
- Coppell JA, Richardson PG, Soiffer R, Martin PL, Kernan NA, Chen A et al. Hepatic veno-occlusive disease following stem cell transplantation: incidence, clinical course, and outcome. Biol Blood Marrow Transplant 2010; 16: 157–168.
- Carreras E, Díaz-Beyá M, Rosiñol L, Martínez C, Fernández-Avilés F and Rovira M. The incidence of veno-occlusive disease following allogeneic hematopoietic stem cell transplantation has diminished and the outcome improved over the last decade. Biol Blood Marrow Transplant 2011; 17: 1713–1720.
- McDonald GB, Hinds MS, Fisher LD, Schoch HG, Wolford JL, Banaji M et al. Veno-occlusive disease of the liver and multiorgan failure after bone marrow transplantation: a cohort study of 355 patients. Ann Intern Med. 1993; 118: 255–267.
- Jones RJ, Lee KS, Beschorner WE, Vogel VG, Grochow LB, Braine HG et al. Venoocclusive disease of the liver following bone marrow transplantation. Transplantation 1987; 44: 778-783.