Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
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 by Surface 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
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.

Keywords: Hepatic sinusoidal obstruction syndrome, Tacrolimus, Refractory ascites, Orthotopic liver transplantation, Case report

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.