Severe Veno-Occlusive Disease in a Child With Wilms Tumor: Acute Management and Subsequent Bridging With Irinotecan Treatment

Background: Hepatic veno-occlusive disease (VOD) is an endothelial injury seen after stem cell transplantation that can also occur with conventional chemotherapies. Morbidity can be significant, highlighting the need for effective supportive care. Case Report: We present a pediatric patient with Wilms tumor who developed VOD after dactinomycin and vincristine. Management included a molecular adsorbent recirculating system (MARS) for acute liver failure and irinotecan with vincristine (VI) as bridging chemotherapy before gradual reintroduction of dactinomycin. Conclusion: The patient remains in remission without long-term VOD complications. MARS facilitated hepatic recovery, and disease control was maintained with VI serving as a low-hepatotoxic bridging regimen before rechallenging with dactinomycin.