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Veno-occlusive disease of the liver after a stem cell transplant | CION Cancer Clinics
VOD, also called SOS, is a liver complication of conditioning that usually appears in the first few weeks after a transplant. Its signs are rapid weight gain, pain under the right ribs, a swollen tummy and yellow eyes. Many cases are mild, some are serious, and early recognition matters most. This page explains the signs, how the team confirms and treats it, and who is at higher risk. At CION Cancer Clinics, our haematology team assesses whether a transplant or CAR-T fits your situation and coordinates care with qualified centres.
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Medically reviewed by Dr. Basudev PokhrelConsultant Haematologist · last reviewed September 2026, next review due September 2027
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On this page
- What is VOD, or SOS, after a transplant?
- What are the signs of VOD after a transplant?
- How do doctors confirm and treat it?
- What do the words on the liver report mean?
- What do families often get wrong about VOD?
- Who is more at risk, and what can this page not tell you?
- Common questions about VOD and SOS after transplant
The short answer
What is VOD, or SOS, after a transplant?
Veno-occlusive disease, now often called sinusoidal obstruction syndrome, is a liver problem caused by conditioning damaging the tiny blood vessels inside the liver. Blood backs up, so the liver swells and hurts, fluid builds up in the body and the eyes may turn yellow.
Why the two names
The older name, VOD, describes veins being blocked. The newer name, SOS, describes more accurately where the damage starts, in the small channels called sinusoids that carry blood through the liver. Your report may use either name, or both together. They mean the same condition.
When it usually appears
Most cases appear in the first few weeks after the stem cells are given, often before counts have recovered. Late cases do happen. That is why the team weighs you daily, measures your tummy, checks liver blood tests and asks about pain under the right ribs even when you feel otherwise well.
How serious it can be
Many cases are mild and settle with careful fluid control. A smaller number become severe, affecting the kidneys and lungs, and need intensive care. Early recognition is what gives the team the most options.
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Report these the same hour
Pain or tenderness under the right ribs, a tummy that is swelling, weight going up quickly, yellow eyes or skin, much less urine, or new confusion or breathlessness. On the ward, press the call bell and tell the nurse. After discharge, call the transplant unit at once or go to the nearest emergency department. Call 108 if the person cannot travel safely.
Not sure whether this applies to you?
Ask an oncologistWhat to watch for
What are the signs of VOD after a transplant?
They can creep up over a few days. No single sign is enough on its own, which is why the team tracks all of them together.
Weight gain
A daily weight that keeps climbing, from fluid the body is holding on to rather than food. Clothes and rings may feel tight. The weight often rises even while the person is eating very little, which is a useful clue for the team.
A painful, swollen liver
Aching or tenderness under the right ribs, sometimes felt when the doctor presses there or when you take a deep breath.
Yellow eyes or skin
Jaundice, a yellow tint that comes from bilirubin building up when the liver is struggling. Urine may look darker.
Fluid in the tummy and legs
The belly becomes swollen and tight, and the ankles or legs puff up.
In severe cases also
- Less urine
- Breathlessness
- Confusion
On the ward
How do doctors confirm and treat it?
Put the signs together
Weight, liver pain, bilirubin and fluid are checked against agreed criteria. The diagnosis is usually made at the bedside from this combination.
An ultrasound scan
A Doppler ultrasound looks at liver size, fluid in the tummy and how blood flows through the liver veins. It also helps rule out other causes.
Careful fluid balance
The team limits salt and fluids through the drip, may give water tablets, and measures every drink and every bit of urine. Some medicines that strain the liver may be changed by the team.
Specific treatment if needed
For moderate or severe cases, a medicine called defibrotide is often used through the drip. Whether it suits depends on bleeding risk and other factors, and availability varies.
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On your report
What do the words on the liver report mean?
- Sinusoids
- Tiny blood channels inside the liver. In SOS, their lining is damaged and they become blocked.
- Bilirubin
- A yellow waste product the liver clears. A rising level causes jaundice. Reference ranges differ between laboratories.
- Ascites
- Fluid collecting inside the tummy, making it swollen and tight.
- Hepatomegaly
- An enlarged liver, often felt as tenderness under the right ribs.
- Reversed portal flow
- An ultrasound finding where blood flows the wrong way in the main liver vein. It supports the diagnosis but is not always present.
Commonly believed
What do families often get wrong about VOD?
"Yellow eyes are just from the antibiotics, it will pass."
Some medicines do affect the liver, but jaundice after a transplant always needs checking the same day. Only the team can say which cause it is.
"If she drinks more water, the swelling will go down."
In VOD the body is already holding too much fluid. Drinking more can make it worse. Follow the fluid plan the nurses set, and ask before offering extra drinks.
"A liver tonic or herbal remedy will protect his liver."
Herbal and ayurvedic liver products can strain the liver further and interact with transplant medicines. Give nothing that the transplant team has not approved.
"This means the transplant has failed."
VOD is a complication of conditioning, not rejection of the new marrow. Many people recover from it and go on to engraft normally, though severe cases are serious.
Being straight with you
Who is more at risk, and what can this page not tell you?
The risk is higher after strong, full-intensity conditioning, especially regimens containing busulfan or high-dose total body irradiation. Existing liver problems, earlier hepatitis, iron overload from many transfusions, a second transplant, and some earlier treatments also raise it. Children and people with thalassaemia can be at higher risk.
Can it be prevented?
Not completely. Teams choose conditioning with liver risk in mind, and many units give a liver-protecting medicine such as ursodeoxycholic acid during the admission. For people at very high risk, some centres consider defibrotide as a preventive step. Practice differs between centres, so ask what the plan is.
How the family can help
Help the nurses keep an accurate record. Note every drink the patient takes, including sips of tea or juice, and tell the nurse. Save urine in the container if you are asked to. Mention any new tightness of the tummy, tight bangles, puffy feet or a yellow tinge to the eyes, even if it seems small. Families who sit with the patient all day often notice these changes first.
What this page cannot tell you
It cannot tell you whether your family member has VOD, how severe it is, or how it will go. That comes from the treating team reading weight, blood tests, scans and kidney and lung function together. Never stop or change a medicine on your own. Ask the team what grade of severity they are seeing and what would change the plan.
Questions we are asked
Common questions about VOD and SOS after transplant
Is VOD the same as SOS?
Yes. Veno-occlusive disease and sinusoidal obstruction syndrome are two names for the same liver complication. SOS is the newer term because the damage begins in the small liver channels called sinusoids. Reports and doctors may use either, sometimes written together as VOD/SOS.
Why do they weigh him every morning?
A quick rise in weight is often the earliest sign of fluid building up, before swelling or yellow eyes appear. Weighing at the same time, on the same scale, in similar clothes, lets the team spot a trend early. Tell the nurse if the scale or timing changes.
Can VOD happen after an autologous transplant?
It can, but it is less common than after donor transplants with strong conditioning. The risk depends mainly on the conditioning drugs, earlier liver damage and previous treatments rather than the stem cell source alone. Ask your team how they rate the risk for this plan.
How is severe VOD treated?
Severe cases need very careful fluid control, support for the kidneys and breathing, sometimes in an intensive care unit, and often a specific medicine called defibrotide. Fluid may be drained from the tummy if it makes breathing hard. The team adjusts the plan day by day.
Will the liver recover fully?
In mild and moderate cases, liver tests usually return towards normal as the condition settles. Severe cases carry more risk and recovery can be slower. This page cannot predict an individual outcome. Ask the treating team how they see the trend in the blood tests and scans.
Is defibrotide covered by schemes or insurance?
It is an expensive medicine and cover varies. Some cashless insurance policies and government schemes such as Aarogyasri, PM-JAY, CGHS, ECHS and EHS may include it within a transplant package, and some may not. Rules change, so ask the centre's billing desk and your insurer to check current cover.
Can we give liver-friendly home foods?
Only what the transplant unit approves. In VOD salt and fluid are often limited, so even healthy soups, coconut water or buttermilk may need to be restricted. Ask the dietitian for a list that fits the fluid plan.
Can CION help us understand a VOD diagnosis?
Yes. CION's haematology team reviews transplant cases, presents them to a tumour board and coordinates care with qualified transplant centres. We can go through the reports with you and help you prepare clear questions for the treating team about risk, treatment and follow-up.
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Sources
- American Cancer Society — Stem Cell Transplant Side Effects
- National Cancer Institute — Stem Cell Transplants in Cancer Treatment
- NHS — Stem cell and bone marrow transplants
- NICE — NICE guidance
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
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Tell us where things stand. Our haematology team will review the reports with you and help you prepare questions for the treating centre. One helpline serves every CION centre.