Noncirrhotic Portal Hypertension Secondary to Nodular Regenerative Hyperplasia Postrenal Transplant

Abstract

Noncirrhotic portal hypertension (NCPH) is a well-known clinical entity, but often underdiagnosed. One of the common causes of NCPH is nodular regenerative hyperplasia (NRH) that presents as nodularity with features of portal hypertension and thus often diagnosed as cirrhosis. Although NRH has no histologic fibrosis, the liver synthetic function remains intact; thus, clinical diagnosis is essential because management may differ from cirrhosis. We were asked to consult in this series of 4 patients who had new-onset ascites after kidney transplantation and were diagnosed with NCPH from NRH.

Ascites development is associated with worse outcome in patients after kidney transplantation

“…Although data is unavailable for the lack of proper testing, we presume that the lack of proper testing is due to the general assumption that all ascites was secondary to cirrhosis or renal failure. During analysis of our reported case series, 3 we noted a similar assumption with the cause attributable to cirrhosis; although the final diagnosis was non‐cirrhotic portal hypertension. On our review of available clinical data in this cohort, there was a broad distribution of etiologies of ascites although the majority of cases were from renal and liver causes.…”

“…Failure to recognize ascites and initiate early workup and management can potentially affect graft function and overall clinical outcomes. Although we noted a specific cause of ascites in the patients that we identified on our inpatient consult service, 3 there are likely many more etiologies that can lead to the ascites; many of which can be managed conservatively. Thus, it is essential to understand the possible causes of ascites in this population and understand pathways for effective management.…”

“…Ascites following kidney transplantation (KT) is believed to be an uncommon but ominous finding that can occur with normal or abnormal kidney function 1‐3 . Ascites can have varying pathophysiology, with the majority of cases in non‐transplanted patients in the United States attributed to hepatic etiologies, most notably cirrhosis (81%) 4‐7 .…”

“…Ascites can have varying pathophysiology, with the majority of cases in non‐transplanted patients in the United States attributed to hepatic etiologies, most notably cirrhosis (81%) 4‐7 . Other causes may include malignancies (10%), heart failure (3%), tuberculosis (2%), besides other etiologies 3,5,8‐10 . Other than limited case reports, no study has characterized the development of ascites in the post‐KT population 1‐3,11 or its effect on overall clinical outcomes.…”

“…Other causes may include malignancies (10%), heart failure (3%), tuberculosis (2%), besides other etiologies 3,5,8‐10 . Other than limited case reports, no study has characterized the development of ascites in the post‐KT population 1‐3,11 or its effect on overall clinical outcomes.…”