Hepatic sinusoidal obstruction syndrome induced by tacrolimus following liver transplantation: Three case reports

Figure 1 Typical abdominal contrast-enhanced computed tomography features of hepatic sinusoidal obstruction syndrome after liver transplantation. A: Portal venous phase computed tomography (CT) on postoperative day (POD) 10 showed the blood flow of hepatic veins were fluent. No stenosis was observed at the vascular anastomosis of hepatic veins and suprahepatic inferior vena cava; B: Portal venous phase CT on POD 14 showed hepatic veins were obscured, while no stenosis was observed at the vascular anastomosis of suprahepatic inferior vena; C, D: Plain scan and arterial phases CT on POD 14 showed that liver parenchyma was heterogeneous low-density; E, F: Portal venous phase CT on POD 14 showed enlarged liver with patchy enhancement, massive ascites and unclear hepatic veins and these signs existed persistently to delayed phase.

Figure 2 Contrast-enhanced computed tomography images of Case 2 before and after switching tacrolimus to sirolimus. A, B, C: Before changing tacrolimus to sirolimus, portal venous phase computed tomography (CT) showed enlarged liver with patchy enhancement, moderate to massive ascites and obscured hepatic veins on postoperative day (POD) 59 after liver transplantation; D, E, F: After switching tacrolimus to sirolimus, portal venous phase CT showed normal liver with resolved patchy enhancement and disappeared ascites, and clear hepatic veins on POD 175.

Figure 3 Typical pathological features of hepatic sinusoidal obstruction syndrome after liver transplantation. A and C: Histopathologic examination of Case 2 showed congestion of hepatic sinusoids, fibrosis of centrilobular veins and edema in portal areas; B and D: Histopathologic examination of Case 3 showed significant dilation and congestion of sinusoids, regional hepatocytes necrosis, infiltration of red blood cells in the space of Disse, and fibroplasias in the portal areas (A, B magnification, × 100; C, D magnification, × 200).