Hepatic veno-occlusive disease after liver transplantation: an unusual case report

Significance of isolated hepatic veno-occlusive disease/sinusoidal obstruction syndrome after liver transplantation

“…In this study, the overall prevalence of VOD/SOS after LT was 2.3% (31/1364), which is statistically similar to the overall prevalence in our previous study (1.9% or 19/1023) 9. This value differs from literature values, with previous studies (even those from centers performing protocol biopsy) mainly reporting sporadic cases 2‐11. The difference is probably related to the histological description of VOD/SOS and AR when they coexist.…”

“…Despite a similar overall prevalence of VOD/SOS over the last 2 decades, the proportion of iVOD/SOS has significantly increased (15/31 versus 2/19, P = 0.006)9 and is similar to the proportion reported in the literature (10/20) 2, 3, 5, 7, 11. None of our patients received azathioprine as part of their immunosuppression.…”

“…VOD/SOS is a rare cause of liver graft dysfunction with a poor prognosis 2‐11. VOD/SOS has been reported to be related initially to azathioprine use11 and subsequently to AR.…”

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“…Several cases with VOD after liver transplant have been reported, involving cases of deceased-donor and living-related, adult and pediatric recipients. [7][8][9][10][11][12] Two review articles of large series mentioned that about 1.9% to 2.3% of patients after deceased donor's liver transplant had VOD at various times after transplant. 8,9 The clinical symptoms related to VOD are nonspecific, which induces the fact that diagnosing of VOD in postliver transplant patients is more difficult and confused than that which occurs in other types of transplants.…”

“…It should be emphasized that recent researches tended to support the hypothesis that immunologic responses may participate in the onset of VOD after liver transplant (including acute cellular and humoral rejection). [7][8][9][10][11][12] Tacrolimus might be another possible agent to induce VOD because it precipitates dysregulation of endothelial cells. 10 But the cases of VOD presumably associated with tacrolimus, are even rarer than azathioprine and immunologic phenomenon.…”