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Veno-occlusive disease (VOD), also known as sinusoidal obstruction syndrome, is a potentially life-threatening complication of hematopoietic stem cell transplant (HSCT), characterized by weight gain, fluid retention with ascites, tender hepatomegaly, and jaundice. The toxicity is believed to result from damage to hepatic sinusoidal endothelial cells, which causes obstructed sinusoidal flow that leads to liver dysfunction, multiorgan failure, and death. The incidence of VOD following HSCT is unclear due to variations in diagnosis but has been reported to be as high as 60%. Specific groups such as children, patients with previous hepatic injury, or those undergoing allogeneic HSCT (as opposed to autologous HSCT) are at increased risk, especially when the conditioning regimen contains chemotherapy, irradiation, or busulfan. In patients with severe cases, the mortality rate has been estimated to be greater than 80%. In addition, VOD has been associated with increased health care system resource utilization and costs (estimated to be $8,988 for mild cases and $41,703 for severe cases). Efforts to control the toxicity must therefore focus on primary prevention and strategies to monitor patients for signs and symptoms so that timely and effective treatment can be initiated.


Oncology nurse practitioners, clinical nurse specialists, nurses, and other health care professionals involved in the management of hepatic veno-occlusive disease.


Upon completion of this activity, participants should be able to:

  • Describe the pathophysiology of VOD
  • Assess the risk for VOD in cancer patients undergoing hematopoietic stem cell transplant
  • Evaluate evidence-based supportive care plans to mitigate VOD in pediatric and adult patients with cancer


Phyllis McKiernan 54x68Phyllis McKiernan, APN, MSN, OCN®
Advanced Practice Nurse
John Theurer Cancer Center

Michelle Rickard 54x68Michelle N. Rickard, DNP, CPNP-AC, CHPPN, BMTCN, CPON
Assistant Professor, College of Nursing
University of Tennessee Health Science Center


There is no fee to participate in or claim CE credit for this activity. 

Jointly Provided by

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USF Health is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.

A maximum of 1.0 contact hour may be earned by learners who successfully complete this continuing nursing education activity.


The program content has been reviewed by the Oncology Nursing Certification Corporation (ONCC) and is acceptable for recertification points.

ONCC review is only for designating content to be used for recertification points and is not for CNE accreditation. CNE programs must be formally approved for contact hours by an acceptable accreditor/approver of nursing CE to be used for recertification by ONCC. If the CNE provider fails to obtain formal approval to award contact hours by an acceptable accrediting/approval body, no information related to ONCC recertification may be used in relation to the program.

OCN®, CPHON®, AOCNP®, and AOCNS® renewal candidates: 1 ILNA point may be applied toward: 
Symptom Management or Oncologic Emergencies .......................1 point     

BMTCN® renewal candidates: 1 ILNA point may be applied toward: 
Post-Transplant Issues .........................................................................1 point     

Please note that some of the course content applies to multiple content areas. The numerical value above indicates the maximum amount of points that can be claimed in each domain. The total amount of ILNA points claimed may not exceed the total amount of CNE awarded from this course.


No prerequisites are required for this activity.


In order to receive credit for this activity, participants must:

  1. Take the pretest
  2. Watch the online video
  3. Pass the posttest with a score of ≥80%
  4. Complete the activity evaluation
  5. Download your certificate of completion


USF Health and i3 Health endorse the standards of the ANCC that require everyone in a position to control the content of a CE activity to disclose all financial relationships with commercial interests that are related to the content of the CE activity. CE activities must be balanced, independent of commercial bias, and promote improvements or quality in healthcare. All recommendations involving clinical medicine must be based on evidence accepted within the medical profession. A conflict of interest is created when individuals in a position to control the content of CE have a relevant financial relationship with a commercial interest which, therefore, may bias his/her opinion and teaching. This may include receiving a salary, royalty, intellectual property rights, consulting fee, honoraria, stocks, or other financial benefits. USF Health will identify, review, and resolve all conflicts of interest that speakers, authors, or planners disclose prior to an educational activity being delivered to learners. Disclosure of a relationship is not intended to suggest or condone bias in any presentation but is made to provide participants with information that might be of potential importance to their evaluation of a presentation. USF Health does not endorse any products or services.

Phyllis McKiernan, APN, MSN, OCN has no financial relationships to disclose.

Michelle N. Rickard, DNP, CPNP-AC, CHPPN, BMTCN, CPON has no financial relationships to disclose.

Planning Committee, USF Health OCPD staff members, i3 Health staff members, and the peer/content reviewer for this activity have no relevant financial relationships to disclose.

Disclosures are on file at the University of South Florida, Office of Continuing Professional Development.


USF Health and i3 Health require CE faculty (speakers) to disclose to attendees when products or procedures being discussed are off-label, unlabeled, experimental, and/or investigational (not FDA approved), as well as any limitations on the information that is presented, such as data that are preliminary or that represent ongoing research, interim analyses, and/or unsupported opinion. Faculty may discuss information about pharmaceutical agents that is outside of U.S. Food and Drug Administration approved labeling. This information is intended solely for continuing medical education and is not intended to promote off-label use of these medications. If you have questions, contact the medical affairs department of the manufacturer for the most recent prescribing information.


The information provided in this CE activity is for continuing education purposes only and is not meant to substitute for the independent medical/clinical judgment of a healthcare provider relative to diagnostic and treatment options of a specific patient’s medical condition.


USF is an Equal Opportunity/Affirmative Action/Equal Access Institution.


This activity is supported by an independent educational grant from Jazz Pharmaceuticals.


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