Diagnosis and management of pulmonary veno-occlusive disease

Expert Rev Respir Med. 2023 Jul-Dec;17(8):635-649. doi: 10.1080/17476348.2023.2247989. Epub 2023 Aug 21.


Introduction: Pulmonary veno-occlusive disease (PVOD) is an orphan disease and uncommon etiology of pulmonary arterial hypertension (PAH) characterized by substantial small pulmonary vein and capillary involvement.

Areas covered: PVOD, also known as 'PAH with features of venous/capillary involvement' in the current ESC/ERS classification.

Expert opinion: In recent years, particular risk factors for PVOD have been recognized, including genetic susceptibilities and environmental factors (such as exposure to occupational organic solvents, chemotherapy, and potentially tobacco). The discovery of biallelic mutations in the EIF2AK4 gene as the cause of heritable PVOD has been a breakthrough in understanding the molecular basis of PVOD. Venous and capillary involvement (PVOD-like) has also been reported to be relatively common in connective tissue disease-associated PAH (especially systemic sclerosis), and in rare pulmonary diseases like sarcoidosis and pulmonary Langerhans cell granulomatosis. Although PVOD and pulmonary arterial hypertension (PAH) exhibit similarities, including severe precapillary PH, it is essential to differentiate between them since PVOD has a worse prognosis and requires specific management. Indeed, PVOD patients are characterized by poor response to PAH-approved drugs, which can lead to pulmonary edema and clinical deterioration. Due to the lack of effective treatments, early referral to a lung transplantation center is crucial.

Keywords: EIF2AK4; Pulmonary veno-occlusive disease; chemotherapy; pulmonary edema; pulmonary hypertension; solvents; transplantation.

Publication types

  • Review

MeSH terms

  • Humans
  • Lung
  • Prognosis
  • Protein Serine-Threonine Kinases / genetics
  • Pulmonary Arterial Hypertension*
  • Pulmonary Veno-Occlusive Disease* / diagnosis
  • Pulmonary Veno-Occlusive Disease* / genetics
  • Pulmonary Veno-Occlusive Disease* / therapy
  • Treatment Outcome


  • EIF2AK4 protein, human
  • Protein Serine-Threonine Kinases