Jiang JY, Fu Y, Ou YJ, Zhang LD. Hepatic sinusoidal obstruction syndrome induced by tacrolimus following liver transplantation: Three case reports. World J Clin Cases 2022; 10(36): 13408-13417 [PMID: PMC9851010 DOI: 10.12998/wjcc.v10.i36.13408]
Corresponding Author of This Article
Lei-Da Zhang, MD, Professor, Institute of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), No. 29 Gaotanyan Street, Shapingba District, Chongqing 400038, China. 2518569931@qq.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Dec 26, 2022; 10(36): 13408-13417 Published online Dec 26, 2022. doi: 10.12998/wjcc.v10.i36.13408
Hepatic sinusoidal obstruction syndrome induced by tacrolimus following liver transplantation: Three case reports
Jia-Yun Jiang, Yu Fu, Yan-Jiao Ou, Lei-Da Zhang
Jia-Yun Jiang, Yan-Jiao Ou, Lei-Da Zhang, Institute of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China
Yu Fu, College of Pharmaceutical Sciences, Southwest University, Chongqing 400715, China
Author contributions: Jiang JY designed the study and wrote the manuscript; Jiang JY and Fu Y collected and analyzed the clinical data; Ou YJ and Zhang LD guided the diagnosis and treatment of HSOS; and all authors contributed to the revision of the manuscript and approved the submitted version.
Supported bySurface Project of National Natural Science Foundation of China, No. 81972760; The Joint Project of Chongqing Health Commission and Science and Technology Bureau, No. 2022QNXM020; Doctoral Through Train Scientific Research Project of Chongqing, No. CSTB2022BSXM-JCX0004.
Informed consent statement: The study performed followed the principles of the Declaration of Helsinki. The requirement for ethical approval was approved by the Ethics Committee of Southwest Hospital, Third Military Medical University (Army Medical University). Written informed consents were obtained from the three patients or their guardians for the publication of this report and the clinical data. A copy of the consent form is available for review by the Editor of this journal.
Conflict-of-interest statement: The authors declare that they have no competing interests.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Lei-Da Zhang, MD, Professor, Institute of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), No. 29 Gaotanyan Street, Shapingba District, Chongqing 400038, China. 2518569931@qq.com
Received: September 8, 2022 Peer-review started: September 8, 2022 First decision: September 27, 2022 Revised: October 7, 2022 Accepted: October 23, 2022 Article in press: October 23, 2022 Published online: December 26, 2022 Processing time: 109 Days and 5.4 Hours
Abstract
BACKGROUND
Hepatic sinusoidal obstruction syndrome (HSOS) is a rare complication in solid organ transplant recipients, especially in liver transplantation recipients. However, the consequences of HSOS occurrence are pernicious, which could result in severe liver or renal failure, and even death. In addition to previously reported azathioprine and acute rejection, tacrolimus is also considered as one predisposing factor to induce HSOS after liver transplantation, although the underlying mechanism remains unclear.
CASE SUMMARY
In this study, we reported three cases of tacrolimus-related HSOS after liver transplantation. The diagnosis of HSOS was firstly based on the typical symptoms including ascites, painful hepatomegaly and jaundice. Furthermore, the features of patchy enhancement on portal vein and delayed phase of abdominal enhanced computed tomography were suspected of HSOS and ultimately confirmed by liver biopsy and histological examination in two patients. A significant decrease in ascites and remission of clinical symptoms of abdominal distention and pain were observed after withdrawal of tacrolimus.
CONCLUSION
Tacrolimus-induced HSOS is a scarce but severe complication after liver transplantation. It lacks specific symptoms and diagnostic criteria. Timely diagnosis of HSOS is based on clinical symptoms, radiological and histological examinations. Discontinuation of tacrolimus is the only effective treatment. Transplantation physicians should be aware of this rare complication potentially induced by tacrolimus.
Core Tip: Tacrolimus-induced hepatic sinusoidal obstruction syndrome (HSOS) is a scarce but severe complication after liver transplantation. It lacks specific symptoms and diagnostic criteria. Timely diagnosis of HSOS is based on clinical symptoms, radiological and histological examinations. Discontinuation of tacrolimus is the only effective treatment. Transplantation physicians should be aware of this rare complication potentially induced by tacrolimus.
