JHEP reports : innovation in hepatology · 2026
Long-term outcome of sinusoidal obstruction syndrome secondary to hematopoietic stem cell transplantation.
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Alvarado-Tapias Edilmar, Sayadi Alexandre, Bertin Lise, Plessier Aurélie, Durand François, Ferrero-Gregori Andreu, Paradis Valérie, Michonneau David, Rautou Pierre-Emmanuel
Аннотация
BACKGROUND & AIMS: Sinusoidal obstruction syndrome (SOS) is a potentially severe complication of conditioning regimens in hematopoietic stem cell transplantation (HSCT). Its long-term outcome is unknown. The aim of this study was to investigate the long-term liver outcome of patients with SOS.
METHODS: We retrospectively analyzed the outcome of all patients with histologically proven SOS related to HSCT conditioning who survived 6 months or more after HSCT. Twenty-two patients with SOS were included.
RESULTS: Median follow-up after SOS was 6.1 years. During this period, 10 patients (45%) developed signs of portal hypertension and eight (36%) of them had liver-related complications (ascites, n = 8; spontaneous bacterial peritonitis, n = 1; hepatic encephalopathy, n = 3; variceal bleeding, n = 3). Cumulative incidence of signs of portal hypertension was 27% at 3 years. Patients who developed signs of portal hypertension were less likely to have received defibrotide (hazard ratio: 0.096; p <0.001) and had lower mean arterial pressure than those who did not. Of the 10 patients who developed signs of portal hypertension during follow-up, three underwent a second liver biopsy; all biopsies showed features of porto-sinusoidal vascular disorder. Cumulative incidence of death, considering non-liver-related death as a competing event, was significantly higher in patients who developed signs of portal hypertension than in those who did not (hazard ratio: 10.7 [1.27-89.9]).
CONCLUSIONS: Development of signs of portal hypertension and liver-related complications are common in the long-term after SOS following HSCT, especially when patients did not receive defibrotide, and this affects patients' survival. Features consistent with a porto-sinusoidal vascular disorder may be seen in liver histology in a subset of patients at the long-term follow-up after SOS.
IMPACT AND IMPLICATIONS: Long-term liver outcome of SOS following conditioning regimens in HSCT is unknown. This study demonstrates that signs of portal hypertension and liver-related complications are common during long-term follow-up after SOS following HSCT. Treatment of SOS with defibrotide seems to be associated with a lower risk of developing portal hypertension. Liver histology at the long-term follow-up after SOS may show features consistent with porto-sinusoidal vascular disorder. SOS following HSCT might thus be removed from the porto-sinusoidal vascular disorder exclusion criteria.
METHODS: We retrospectively analyzed the outcome of all patients with histologically proven SOS related to HSCT conditioning who survived 6 months or more after HSCT. Twenty-two patients with SOS were included.
RESULTS: Median follow-up after SOS was 6.1 years. During this period, 10 patients (45%) developed signs of portal hypertension and eight (36%) of them had liver-related complications (ascites, n = 8; spontaneous bacterial peritonitis, n = 1; hepatic encephalopathy, n = 3; variceal bleeding, n = 3). Cumulative incidence of signs of portal hypertension was 27% at 3 years. Patients who developed signs of portal hypertension were less likely to have received defibrotide (hazard ratio: 0.096; p <0.001) and had lower mean arterial pressure than those who did not. Of the 10 patients who developed signs of portal hypertension during follow-up, three underwent a second liver biopsy; all biopsies showed features of porto-sinusoidal vascular disorder. Cumulative incidence of death, considering non-liver-related death as a competing event, was significantly higher in patients who developed signs of portal hypertension than in those who did not (hazard ratio: 10.7 [1.27-89.9]).
CONCLUSIONS: Development of signs of portal hypertension and liver-related complications are common in the long-term after SOS following HSCT, especially when patients did not receive defibrotide, and this affects patients' survival. Features consistent with a porto-sinusoidal vascular disorder may be seen in liver histology in a subset of patients at the long-term follow-up after SOS.
IMPACT AND IMPLICATIONS: Long-term liver outcome of SOS following conditioning regimens in HSCT is unknown. This study demonstrates that signs of portal hypertension and liver-related complications are common during long-term follow-up after SOS following HSCT. Treatment of SOS with defibrotide seems to be associated with a lower risk of developing portal hypertension. Liver histology at the long-term follow-up after SOS may show features consistent with porto-sinusoidal vascular disorder. SOS following HSCT might thus be removed from the porto-sinusoidal vascular disorder exclusion criteria.