Purpose: To evaluate the usefulness of two-dimensional shear wave elastography (2D-SWE) in diagnosing hepatic veno-occlusive disease (VOD) in pediatric patients.Methods: This study retrospectively included pediatric patients who underwent hematopoietic stem cell transplantation (HSCT) between November 2019 and January 2021. All 34 patients (8.7 ± 5.0 years) were examined using 2D-SWE for an initial diagnosis. Subgroup analysis was performed using the data from follow-up examinations of patients diagnosed with VOD. The characteristics of the initial VOD diagnosis were compared with the longitudinal changes observed in VOD patients who underwent multiple ultrasound examinations.Results: In total, 19 patients were diagnosed with VOD at 17.6 ± 9.4 days after HSCT. All VOD patients showed hepatomegaly, ascites, and gallbladder wall thickening. Liver stiffness was higher in VOD patients than those in the non-VOD group (12.4 ± 1.1 vs. 6.3 ± 0.8 kPa, P < 0.001). Liver stiffness values above 7.2 kPa showed 84.2% sensitivity and 93.3% specificity in distinguishing VOD from non-VOD (area under the curve = 0.925; 95% confidence interval = 0.780 -0.987; P < 0.001). Subgroup analysis of 11 of the patients showed a linear decrease in liver stiffness values after VOD diagnosis with treatment (first, second, and third follow-ups; 13.5 ± 1.7, 11.3 ± 1.4, 9.5 ± 0.8 kPa, respectively), but without statistical significance in the pairwise analysis. Conclusion:Liver stiffness measured using 2D-SWE increases in pediatric patients who develop VOD after HSCT. Therefore, liver stiffness can be a predictive and quantitative parameter for diagnosing VOD.