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 criteriaBaltimore criteria
At least two of the following, occurring within 20d of transplantation:
  • Serum bilirubin > 34 umol/L (> 2mg/dL)
  • Hepatomegaly with right upper quadrant pain
  • > 2% weight gain from baseline due to fluid retention
Serum bilirubin > 34 umol/L (> 2mg/dL) within 21d of transplantation AND at least two of the following:
  • Hepatomegaly
  • > 5% weight gain from baseline
  • Ascites

2. Determine severity (Seattle criteria)

MildNo adverse effects of liver disease, AND
No medications required for diuresis or hepatic pain, AND
All symptoms, signs and laboratory features reversible
ModerateAdverse 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
SevereAdverse effects of liver disease present, AND
Symptoms, signs or laboratory features not resolved by day +100, OR

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