A case of late-onset hepatic sinusoidal obstruction syndrome/veno-occlusive disease after hematopoietic stem cell transplantation: usefulness of ultrasonography (liver stiffness measurement) for diagnosis and follow-up

Abstract

A 32-year-old woman had undergone allogeneic hematopoietic stem cell transplantation for the treatment of acute myeloid leukemia. Liver stiffness (LS) at admission was 3.5 KPa. Weight gain, abdominal pain, and elevated serum total bilirubin level were observed approximately 67 days after transplantation. Ultrasonography (US) and LS measurement (LSM) were performed. LS was markedly high (at 42.2 KPa), and US revealed hepatomegaly, ascites, and decreased portal venous flow. The patient was diagnosed with late-onset sinusoidal obstruction syndrome/veno-occlusive disease (SOS/VOD). After administration of recombinant thrombomodulin, fresh frozen plasma, and low-molecular-weight heparin, LS decreased, portal blood flow improved, and serum bilirubin level decreased. Moreover, LS decreased to 25.4 and 4.9 KPa after 115 and 342 days, respectively. The diagnosis of SOS/VOD was based on clinical symptoms and US findings, and the hepatic hemodynamics were included in the diagnostic criteria for late-onset SOS/VOD (European Society for Blood marrow transplantation, 2016). However, Doppler blood flow measurement is skill-dependent and time-consuming. LS can be measured quickly, easily, and repeatedly, even by unskilled examiners. Therefore, LSM may be useful for the diagnosis and follow-up of late-onset SOS/VOD.