Supplementary Material for: Percutaneous Hepatic Perfusion Melphalan Induced Sinusoidal Obstruction Syndrome (Veno-Occlusive Disease) in a Patient with Metastatic Uveal Melanoma

Percutaneous hepatic perfusion using the HEPZATO KIT™ (Delcath Systems, Inc., Queensbury, NY) is an U.S. Food and Drug Administration approved treatment for liver metastases from uveal melanoma. We discuss the development of sinusoidal obstruction syndrome/veno-occlusive disease after treatment using percutaneous hepatic perfusion. The patient is a 49-year-old male with a history of hepatic metastatic uveal melanoma. Despite several rounds of trans-arterial chemoembolization, the patient had progression of liver disease and was then treated with percutaneous hepatic perfusion. Several weeks later, the patient was found to have liver injury and was diagnosed with biopsy-proven sinusoidal obstruction syndrome. He was treated with defibrotide and symptoms resolved but passed away several months later due to progression in metastatic disease. To our knowledge, this represents the first case of sinusoidal obstruction syndrome after Melphalan administration for percutaneous hepatic perfusion. Rapid progression of disease versus sinusoidal obstruction disease must be considered in patients who present with signs of liver injury/failure after this procedure as prompt diagnosis and treatment are crucial.