Tacrolimus-associated sinus obstruction syndrome after liver transplantation from a living related donor

Sinusoidal obstruction syndrome (SOS), previously known as hepatic veno-occlusive disease, is manifested by obliterating inflammation of the terminal hepatic veins, characterized by hepatomegaly, right upper quadrant pain, jaundice and ascites, and most often occurs in patients after hematopoietic stem cell transplantation and usually in those who received platinum drugs. Cases of SOS development in patients after transplantation of solid organs (lungs, pancreas, liver) are also recorded in the world literature. Cases of the development of SOS after transplantation of solid organs are rare, and after transplantation of the liver lobe from a living family donor - isolated and poorly studied. The diagnosis is established on the basis of clinical signs, imaging techniques (according to ultrasound and radiological research methods), histological study of a liver biopsy. Tacrolimus has been reported to be a causative agent that potentially plays a role in the pathophysiological mechanism of SOS. Purpose - to study the relationship between prolonged-release tacrolimus and the development of sinusoidal obstruction syndrome in patients after living donor liver transplantation. Clinical case. In this article, we present a case of SOS after living donor liver transplantation, which was associated with the toxic effect of prolonged-release tacrolimus («Envarsus»). In a 55-year-old man, after living donor liver transplantation, high concentrations of tacrolimus in the blood associated with uncontrolled drug intake were recorded. When carrying out a number of laboratory and instrumental research methods in connection with the appearance of massive ascites, the diagnosis of SOS was established. After excluding other possible contributing factors, including an acute rejection crisis, it was concluded that long-acting tacrolimus («Envarsus») was the cause of SOS. The research was carried out in accordance with the principles of the Helsinki Declaration. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.