Sinusoidal obstruction syndrome of the liver after hematopoietic stem cell transplantation: decision making for orthotopic liver transplantation.
Sinusoidal obstruction syndrome (SOS) is a specific complication of hematopoietic stem cell transplantation (HSCT) that can lead to substantial morbidity and treatment-related mortality. Heparin is frequently used as prophylaxis of and defibrotide as therapy for mild to moderate SOS. In severe cases of SOS these therapies are often ineffective, and orthotopic liver trans-plantation (OLT) may be the only option. Reports in the literature about the outcome of liver transplantation for SOS are contradictory. We describe our second case of OLT after HSCT. The patient died of intracranial hemorrhage 2 weeks after liver transplantation with good initial organ function. In the first case at our center, however, the patient survived more then 8 years. The reported short- to medium-range survival rate for OLT following HSCT is approximately 50%. On the basis of the experience at our center and the findings in a review of the literature, we developed a rational approach to the selection for liver transplantation of patients with life-threatening liver dysfunction after marrow transplantation.
Koenecke
Christian
C
Departments of Hematology, Hemostasis and Oncology, Hannover Medical School, Hannover, Germany. koenecke.christian@mh-hannover.de
Kleine
Moritz
M
Schrem
Harald
H
Krug
Utz
U
Nashan
Bjoern
B
Neipp
Michael
M
Ganser
Arnold
A
Hertenstein
Bernd
B
Klempnauer
Juergen
J
D000754:Anemia, Refractory, with Excess of Blasts / Q000150:complications / Q000628:therapy*; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006504:Hepatic Veno-Occlusive Disease / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D006801:Humans; D016031:Liver Transplantation; D008875:Middle Aged; D017211:Treatment Failure