Tacrolimus-induced Sinusoidal Obstruction Syndrome after Liver Transplant: A Report of a Rare Case

Abstract

Tacrolimus-induced hepatic sinusoidal obstruction syndrome (HSOS) is a rare complication after a solid organ transplant, especially in liver transplantation (LT) recipients. Nevertheless, the consequence of HSOS could result in severe liver or renal failure and even mortality. Most of the previous reports diagnosed HSOS with the help of liver biopsy, and the treatment remains a withdrawal of causative agent. In this study, we report a case of tacrolimus-induced HSOS after LT. Initially, HSOS was suspected based on typical symptoms including ascites, weight gain, and hepatomegaly. Further, the features of typical patchy enhancement of liver parenchyma on the venous phase of contrast-enhanced computed tomography (CECT) confirmed the diagnosis of HSOS. After replacing tacrolimus with cyclosporine, there was a complete resolution of ascites and clinical symptoms, which was confirmed again with repeat CECT showing normal enhancement of liver parenchyma. Tacrolimus-induced HSOS is a rare complication. Timely diagnosis of HSOS is based on clinical symptoms and typical radiological findings. Tacrolimus withdrawal remains the only effective treatment.