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E-Poster Submission Deadline
Please prepare and upload your E-Poster no later than March 14, 2026 11.59PM CET. After this date, you will no longer be able to prepare and upload your E-poster and it will not be displayed and accessible on the congress website.
Please follow the instructions below to input your abstract title.
Abstract titles should be brief and reflect the content of the abstract.
Veno-occlusive disease (VOD) is a potentially life-threatening complication following hematopoietic stem cell transplantation. It is characterized by hepatomegaly, hyperbilirubinemia, fluid retention, and progressive multi-organ dysfunction. Although it primarily affects the liver, VOD frequently leads to renal injury, particularly in its severe forms.
Kidney biopsy is rarely performed in these patients due to bleeding risk. Acute tubular injury is often secondary to systemic inflammation, ischemia, and volume overload. Defibrotide remains the only available therapy.
Male of 34 years with recently diagnosed Acute Leukemia who received fludarabine and total body irradiation, followed by an allogeneic bone marrow transplant. On day 11, he experienced fever, right upper quadrant abdominal pain, diarrhea, and vomiting coincident with elevated levels of prophylactic tacrolimus (12-14 ng/mL) but no hemodynamic instability. His baseline S Cr was 0.5 mg/dL, which slowly started rising to 2.3 mg/dL; he failed to improve with intravascular volume expansion with albumin 5%. Relevant lab work included WBC <0.01 k/uL, Hb 5.8 g/dL, MCV 93 FL, platelet count 4 k/uL. Tacrolimus trough level 12.3 ng/mL. Total bilirubin 2.3 mg/dl, AST 98 U/L AST 92 U/L, normal lipase, albumin 2.7 g/dl. His UA with micro showed RBC >100 hpf non-dysmorphic, granular casts 6-10 lpf, negative for protein. Imaging demonstrated hepatomegaly, and a horseshoe kidney with no hydronephrosis. Admitted to the ICU, blood cultures ½ bottles positive for Staphylococcus epidermidis. The coincident cholestatic pattern, in addition to AKI after bone marrow transplant, made VOD very likely. He was started on defibrotide 500 mg IV q6hr, which was held after 14 days due to hematuria; he remains dialysis dependent.
VOD/SOS remains a diagnostic challenge given the lack of pathognomonic findings. The European Society for Blood and Marrow Transplantation is the best diagnostic criteria due to its sensitivity, which allows early detection and treatment. Defibrotide is the first and only FDA-approved therapy for severe VOD/SOS. This case supports the notion that urinary findings and clinical context can offer meaningful diagnostic clues when histological confirmation is not possible, reinforcing the need for heightened clinical suspicion of VOD-associated renal injury.
