Introduction : Sinusoidal obstructive syndrome is a serious and often lethal complication of hematopoietic stem cell transplantation.

Methods : We describe the case of a young man who underwent liver transplantation for life-threatening severe sinusoidal obstructive syndrome (SOS) following stem cell transplantation for acute lymphocytic leukemia.

Results : A 35-yr-old male diagnosed with acute lymphocytic leukemia underwent a matched unrelated peripheral blood stem cell transplant. Within one month, he developed jaundice, ascites, and weight gain, and was diagnosed with biopsy-proven SOS. Despite therapy with defibrotide, he continued to deteriorate with the development of intractable pleural effusion and progressive renal failure. The patient underwent orthotopic liver transplantation.Up to now, on postoperative day 50, although the drain is maintained for the control of ascites and pleural effusion, the amount of those is gradually decreasing and maintaining normal liver function. Also, the patient achieved complete hematologic remission.

Conclusions : Severe SOS in the setting of stem cell transplantation betokens a poor prognosis. Based on our center’s experience, we suggest that orthotopic liver transplantation may be a feasible and potentially effective approach to managing select patients with life-threatening liver dysfunction after hematopoietic stem cell transplantation.