Search

The sinusoidal obstructive syndrome is a complication typically associated with hematopoietic stem cell transplantation. This syndrome, more commonly known as veno-occlusive disease, has also been described after liver transplantation. It can have a life-threatening course. Herein, we describe the hepatic graft loss secondary to the development of a sinusoidal obstructive syndrome after a severe acute cellular rejection and toxic levels of once daily modified released tacrolimus (TAC). We discuss the role of the endotheliitis of acute rejection and toxic metabolites of some immunosuppressants such as azathioprine and TAC. Based on the current scientific evidence, we contemplate the possibility that the etiology of sinusoidal obstruction syndrome post-liver transplantation is multifactorial. El síndrome obstructivo sinusoidal hepático, anteriormente conocido como enfermedad veno-oclusiva, es una complicación típicamente asociada al trasplante de precursores hematopoyéticos. También se ha descrito su asociación con el trasplante hepático. Puede llegar a ser una causa de mortalidad. En este documento se describe la pérdida de un injerto hepático como consecuencia del desarrollo de un síndrome de obstrucción sinusoidal, insistiendo en la evolución del mismo y su relación con el rechazo agudo celular y los niveles tóxicos de tacrolimus en plasma. Basándonos en la evidencia actual, discutimos sobre la posibilidad de que la etiología del síndrome de obstrucción sinusoidal postrasplante hepático sea multifactorial, puesto que se relaciona con la endotelitis del rechazo agudo y los metabolitos tóxicos de algunos inmunosupresores, como la azatioprina y el tacrolimus.

The sinusoidal obstructive syndrome is a complication typically associated with hematopoietic stem cell transplantation. This syndrome, more commonly known as veno-occlusive disease, has also been described after liver transplantation. It can have a life-threatening course. Herein, we describe the hepatic graft loss secondary to the development of a sinusoidal obstructive syndrome after a severe acute cellular rejection and toxic levels of once daily modified released tacrolimus (TAC). We discuss the role of the endotheliitis of acute rejection and toxic metabolites of some immunosuppressants such as azathioprine and TAC. Based on the current scientific evidence, we contemplate the possibility that the etiology of sinusoidal obstruction syndrome post-liver transplantation is multifactorial.