Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jan 16, 2021; 9(2): 489-495
Published online Jan 16, 2021. doi: 10.12998/wjcc.v9.i2.489
Is sinusoidal obstructive syndrome a recurrent disease after liver transplantation? A case report
Ying Liu, Li-Ying Sun, Zhi-Jun Zhu, Lin Wei, Wei Qu, Zhi-Gui Zeng
Ying Liu, Zhi-Jun Zhu, Lin Wei, Wei Qu, Zhi-Gui Zeng, Liver Transplantation Center, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
Li-Ying Sun, Intensive Care Unit, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
Author contributions: Liu Y was involved in concept/design, data collection, data analysis/interpretation, drafting the article and critical revision of the manuscript; Sun LY conceived and designed the study; Zhu ZJ, Wei L, Qu W and Zeng ZG participated in the performance of the research; All authors issued final approval for the version to be submitted.
Supported by Beijing Municipal Science & Technology Commission, No. Z181100001718220.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
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:
Corresponding author: Li-Ying Sun, PhD, Chief Doctor, Intensive Care Unit, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong-an Road, Beijing 100050, China.
Received: September 20, 2020
Peer-review started: September 20, 2020
First decision: September 29, 2020
Revised: October 9, 2020
Accepted: November 29, 2020
Article in press: November 29, 2020
Published online: January 16, 2021

Sinusoidal obstructive syndrome (SOS) is a disease that damages hepatic sinusoidal endothelial cells, resulting in progressive occlusion and fibrosis of the lobular central vein and the occurrence of intrahepatic sinusoidal portal hypertension. However, SOS after liver transplantation (LT) is uncommon and potentially fatal. Here, we report a rare case of second-time recurrence of SOS after liver retransplantation (rLT).


A 22-year-old woman received a living donor LT due to SOS. Four years later, she developed abdominal distention and ascites with no apparent cause. She was diagnosed with recurrence of SOS and underwent rLT. But 2 mo post rLT, the patient suffered from aggravated jaundice and ascites again. She was diagnosed with second-time recurrence of SOS post-rLT according to computed tomography and liver pathology. After treatment with warfarin anticoagulation and immunosuppressant conversion, she gradually recovered with improvement of liver function and liver pathology. During the 17-mo follow-up period, she was in good condition with normal liver function and no ascites.


SOS can be a recurrent disease after LT, and autoimmune antibody and genetic sequencing should be screened before LT. For susceptible patients, anticoagulant drugs should be used for an extended period, and tacrolimus or other pathogenic agents should be avoided. Early diagnosis and treatment can improve the prognosis of patients and avoid graft failure or death.

Keywords: Sinusoidal obstructive syndrome, Liver transplantation, Recurrence, Sinusoidal dilatation and congestion, Patchy enhancement, Case report

Core Tip: Sinusoidal obstructive syndrome (SOS) is a complex entity with incompletely defined pathogenesis. It is also an uncommon complication after liver transplantation. We reported a rare case of SOS that recurred twice in liver allografts. We believed that this condition is uncommon and has rarely been reported in liver transplant recipients.