• Tae Beom Lee, Kwangho Yang, Hyo Jung Ko, Jae Ryong Shim, Byung Hyun Choi, Jung Hee Lee, and Je Ho Ryu.
• Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery.
• Medicine (Baltimore). 2021 Jun 25; 100 (25): e26463e26463.

RationaleVeno-occlusive disease (VOD) is characterized by painful hepatomegaly, ascites, weight gain, and jaundice with nonthrombotic, fibrous obliteration of the centrilobular hepatic veins. VOD after liver transplantation is a rare complication, with an incidence of approximately 2%; however, it can be life-threatening in severe cases. The precise etiology and mechanism of VOD after liver transplantation remains unclear. Acute cellular rejection, antibody-mediated rejection, and treatment with tacrolimus or azathioprine may be associated with the development of VOD after liver transplantation. Additionally, the optimal treatment of VOD after liver transplantation has not yet been established and focuses on supportive care. Defibrotide is an anti-ischemic and antithrombotic drug with no systemic anticoagulant effects. Moreover, only a few reports have investigated the use of defibrotide for VOD after liver transplantation, which has shown promising results.Patient ConcernsA 39-year-old woman with primary biliary cholangitis underwent living-donor liver transplantation at our center. She experienced right upper quadrant pain with increased ascites, pleural effusion, and weight gain on postoperative day 14.DiagnosesImaging and pathological tests showed no evidence of rejection or vessel complications. VOD was diagnosed clinically based on the findings of weight gain, ascites, jaundice, and pathological biopsy.InterventionsDefibrotid, 25 mg/kg/day, was administered intravenously for 21 days.OutcomesShe showed complete clinical resolution of the VOD.LessonsHerein, we report a case of successful defibrotide treatment of VOD after living-donor liver transplantation.Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.

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