Is the sinusoidal obstructive syndrome post-liver transplantation a pathologic entity with a multifactorial etiology?

• Main Authors: Luis Miguel Marín-Gómez, José María Álamo-Martínez, Gonzalo Suárez-Artacho, José Ramírez-Santos, Carmen Bernal-Bellido, Lydia Barrera-Pulido, Juan Serrano-Díaz-Canedo, Francisco Javier Padillo-Ruiz, Miguel Ángel Gómez-Bravo
• Format: Article
• Language: English
• Published: Aran Ediciones
• Series: Revista Espanola de Enfermedades Digestivas
• Subjects: síndrome de obstrucción sinusoidal; toxicidad por fármacos; rechazo al trasplante
• Online Access: http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1130-01082015000400011&lng=en&tlng=en

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.