Proposed EBMT scale for grading VOD/SOS severity in adults
| Clinical measure: highest grade with ≥2 symptoms . | Mild . | Moderate . | Severe . | Very severe (all patients with MOD/MOF) . |
|---|---|---|---|---|
| Time since first VOD/SOS symptoms* | >7 d | 5–7 d | ≤4 d | Any time |
| Bilirubin | ||||
| mg/dL | ≥2 and <3 | ≥3 and <5 | ≥5 and <8 | ≥8 |
| μmol/L | ≥34 and <51 | ≥51 and <85 | ≥85 and <136 | ≥136 |
| Kinetics | — | — | Doubling within 48 h | — |
| Transaminases | ≤2× normal | >2 and ≤5× normal | >5 and ≤8× normal | >8× normal |
| Weight above baseline | >5% | ≥5% and <10% | ≥5% and >10% | ≥10% |
| Renal function | <1.2× baseline at transplant | ≥1.2 and <1.5× baseline at transplant | ≥1.5 and <2× baseline at transplant | ≥2× baseline at transplant or other signs of MOD/MOF |
| Risk factor adjustment† | Mild + ≥2 risk factors | Moderate + ≥2 risk factors | ||
| Treatment options to consider101 | Maintain fluid and sodium balance | Mild treatments plus: | Moderate treatments plus: | Severe treatments plus: |
| Avoid hepatotoxic/nephrotoxic drugs | If symptoms/signs persist or progress after 2 d, start pharmacologic VOD/SOS therapy | Start pharmacologic VOD/SOS therapy | Hemodialysis/hemofiltration if required | |
| Careful use of diuretics | If hemodynamic data are available, start pharmacologic VOD/SOS therapy for patients with hepatic venous gradient pressure ≥10 mmHg | |||
| Symptomatic treatment: analgesia, oxygen, thoracentesis, paracentesis (remove <1 L/d ascites to avoid reduced renal flow) | ||||
| Progression of symptoms justifies pharmacologic VOD/SOS therapy |
| Clinical measure: highest grade with ≥2 symptoms . | Mild . | Moderate . | Severe . | Very severe (all patients with MOD/MOF) . |
|---|---|---|---|---|
| Time since first VOD/SOS symptoms* | >7 d | 5–7 d | ≤4 d | Any time |
| Bilirubin | ||||
| mg/dL | ≥2 and <3 | ≥3 and <5 | ≥5 and <8 | ≥8 |
| μmol/L | ≥34 and <51 | ≥51 and <85 | ≥85 and <136 | ≥136 |
| Kinetics | — | — | Doubling within 48 h | — |
| Transaminases | ≤2× normal | >2 and ≤5× normal | >5 and ≤8× normal | >8× normal |
| Weight above baseline | >5% | ≥5% and <10% | ≥5% and >10% | ≥10% |
| Renal function | <1.2× baseline at transplant | ≥1.2 and <1.5× baseline at transplant | ≥1.5 and <2× baseline at transplant | ≥2× baseline at transplant or other signs of MOD/MOF |
| Risk factor adjustment† | Mild + ≥2 risk factors | Moderate + ≥2 risk factors | ||
| Treatment options to consider101 | Maintain fluid and sodium balance | Mild treatments plus: | Moderate treatments plus: | Severe treatments plus: |
| Avoid hepatotoxic/nephrotoxic drugs | If symptoms/signs persist or progress after 2 d, start pharmacologic VOD/SOS therapy | Start pharmacologic VOD/SOS therapy | Hemodialysis/hemofiltration if required | |
| Careful use of diuretics | If hemodynamic data are available, start pharmacologic VOD/SOS therapy for patients with hepatic venous gradient pressure ≥10 mmHg | |||
| Symptomatic treatment: analgesia, oxygen, thoracentesis, paracentesis (remove <1 L/d ascites to avoid reduced renal flow) | ||||
| Progression of symptoms justifies pharmacologic VOD/SOS therapy |
Time from the date when the first signs/symptoms of VOD/SOS began to appear (retrospectively determined) and the date when the symptoms fulfilled VOD/SOS diagnostic criteria.
In the presence of ≥2 risk factors (see Table 1), severity is considered 1 grade higher.
Adapted from Richardson et al102 with permission.