Gallbladder wall oedema and ascites are independent predictors of progression to hepatic veno-occlusive disease for children with hematopoietic stem cell transplantation

Objectives To evaluate the predictive value of ultrasonography in children with clinically suspicious hepatic veno-occlusive disease (VOD) after hematopoietic stem cell transplantation (HSCT). Methods Among 216 children who underwent HSCT, 70 also underwent colour Doppler ultrasonography. Of these, 59 had only one sign/symptom, which did not fulfil the diagnostic criteria (clinical suspicion of VOD) at that time. VOD was confirmed in 20 patients (VOD group), while 39 had other conditions (non-VOD group). The following findings were reviewed and compared between groups: left portal vein (peak velocity, direction), left hepatic artery (peak-systolic/end-diastolic velocities, resistive index), middle hepatic vein (peak velocity, phasicity), hepatomegaly, splenomegaly, gallbladder wall thickness, and ascites. Results The VOD group showed significantly higher reversed flow in portal vein ( P = 0.011), peak systolic velocity of left hepatic artery ( P = 0.028), monophasicity of middle hepatic vein ( P = 0.015), hepatomegaly ( P = 0.001), gallbladder wall thickness ( P < 0.001), and ascites ( P < 0.001). Multivariate regression revealed that gallbladder wall thickness and ascites (odds ratio = 35.370, 56.393) were associated with VOD. Conclusions The presence of reversed flow in portal vein, increased peak systolic velocity of hepatic artery, monophasicity of hepatic vein, hepatomegaly, gallbladder wall thickness, and ascites were significantly associated with progression to VOD in children with clinically suspicious VOD after HSCT. Key Points • Ultrasonography with Doppler can help predict progression to VOD. • Gallbladder wall oedema and ascites are the independent predictors of progression to VOD.