Role of liver transplantation for sinusoidal obstruction syndrome following hematopoietic stem cell transplantation

Sinusoidal obstruction syndrome (SOS) is a rare but dismal complication of high-dose chemotherapy with or without hematopoietic stem cell transplantation (HSCT),  with a survival of 20% for the very severe form of the disease, despite defibrotide and modern intensive care. Data on liver transplantation for SOS in this setting are limited. The only available study is a review article gathering 20 cases, including 5 from an American transplantation database and 15 derived from 15 case reports published in the literature. This review indicates a survival rate of 40% after a median follow-up of 1.5 years. Also, a sub-analysis of the EBMT registry about solid organ transplantation associated with case reports published showed a survival rate of 33% at 1 year for liver transplant for SOS (n=18) between 1990 and 2015. The lack of solid and updated data has prevented international societies from providing a recommendation on the role of liver transplantation in SOS management.