Sinusoidal obstruction syndrome (SOS) is a rare, life-threatening clinical syndrome resulting from sinusoidal congestion, and it is characterized by hepatomegaly, ascites, weight gain, and jaundice. The frequency of this condition after liver transplantation (LT) is low, but when SOS is severe and refractory to medical therapy, the ultimate solution is retransplantation. We describe a patient with SOS after LT who was successfully treated by the placement of a transjugular intrahepatic portosystemic shunt (TIPS). Although information on this approach is scarce because of the low incidence of SOS in LT patients, we review the available literature on treating this condition with a TIPS. On the basis of the reported information and our patient's outcome, we suggest that prompt TIPS placement can be considered for SOS when medical treatment fails. Nonetheless, a formal assessment and prospective studies are needed to confidently indicate TIPS placement in this situation. In November 2008, a 54-year-old man underwent liver transplantation (LT) for end-stage liver disease due to a chronic hepatitis B virus (HBV) infection and alcohol abuse. The patient concurrently had a human immunodeficiency virus (HIV) infection; he had no history of opportunistic infections and a total CD4 þ cell count of 536 cells/mL. At the time of LT, he had an undetectable viral load and was receiving antiretroviral therapy (245 mg of tenofovir daily, 200 mg of emtricitabine daily, and 400 mg of raltegravir every 12 hours). His postoperative course was uneventful, and there was no evidence of rejection or infectious complications. His immunosuppressive regimen included tacrolimus and prednisone. For the prevention of recurrent HBV infections, he received tenofovir, emtricitabine, and long-term hepatitis B immune globulin following the standard hospital protocol.Two months after transplantation, the patient was admitted to the hospital because of ascites, peripheral edema (weight gain ¼ 16 kg or 21%), hepatomegaly, and impaired renal function. The serum creatinine concentration was 2.7 mg/dL, and the glomerular filtration rate, which was calculated with the Modification of Diet in Renal Disease formula, was 25.6 mL/ minute. He had no evidence of proteinuria or urinary