A 32-year-old man with hepatitis C who developed progressive liver failure after a bone marrow transplant

We describe the case of a 32-year-old man with hepatitis C infection and minimal pre-existing liver injury prior to a bone marrow transplantation, who developed veno-occlusive disease and progressive liver failure posttransplant. A transjugular liver biopsy performed at day 11 after transplantation for ascites and hyperbilirubinemia showed features of veno-occlusive disease. In an effort to control the clinical course, a trans-jugular intrahepatic porto-systemic shunt was placed; thrombolytic therapy with tissue plasminogen activator (t-PA) and antithrombin III was instituted on day 15 post-BMT. The patient did not respond to the therapeutic measures. He expired 25 days after the transplant from pulmonary hemorrhage and liver failure due to hepatic VOD.