Veno-Occlusive Hepatic Disease of the Liver in Renal Transplantation: Is Azathioprine the Cause?

Liaño, Fernando; Moreno, Alberto; Matesanz, Rafael; Teruel, J.L.; Redondo, Clara; García-Martín, Florencio; Orte, L; Ortuño, J

doi:10.1159/000185385

Cited by 58 publications

(18 citation statements)

References 15 publications

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“…263 Hepatic veno-occlusive disease has also been reported and is found most often in patients with nondermatologic diseases, mostly renal transplantation patients or patients with gastroenterologic disorders. [266][267][268][269][270][271][272] Malignancy potential…”

Section: Uncommon Side Effectsmentioning

confidence: 99%

Azathioprine in dermatology: The past, the present, and the future

Patel

Swerlick

McCall

2006

Journal of the American Academy of Dermatology

160

136

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Section: Uncommon Side Effectsmentioning

confidence: 99%

Azathioprine in dermatology: The past, the present, and the future

Patel

Swerlick

McCall

2006

Journal of the American Academy of Dermatology

160

136

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“…13 In the largest series of kidney transplant recipients, the reported incidence ranged from 2% to 5%. 10 The incidence of clinical SOS in the largest series of LT recipients was 1.9%; this value contrasts with the 43% rate of silent reversible hepatic venular stenosis reported in another study. 9 In this setting, SOS is considered a part of the cellular rejection process with an endothelial predilection and is mainly related to azathioprine.…”

mentioning

confidence: 70%

“…[8][9][10] The easily recognizable central vein occlusion occurring in patients with this condition inspired the name hepatic veno-occlusive disease. Nonetheless, central vein involvement is not an essential feature because the disease process originates in the sinusoids.…”

mentioning

confidence: 99%

Transjugular intrahepatic portosystemic shunt for the treatment of sinusoidal obstruction syndrome in a liver transplant recipient and review of the literature

et al. 2012

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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

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“…4,5 The number of reported HVOD cases after solid organ transplantation is rather low, and most of them are sporadically reported, with an incidence of 1.9e2.5% after kidney transplantation, and HVOD cases seem to differ from one organ to another. 1,2,6,9 In these reports, HVOD is generally linked to the administration of azathioprine. 2,10e12 Tacrolimus, a calcinurin inhibitor, is currently one of the most common potent immunosuppressants used in organ transplantations.…”

Section: Discussionmentioning

confidence: 99%

Hepatic veno-occlusive disease related to tacrolimus after pancreas transplantation

Wang¹,

Shyr²,

Lee³

2013

Journal of the Chinese Medical Association

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Hepatic veno-occlusive disease (HVOD) describes the nonthrombotic, fibrous obliteration of the small centrilobular hepatic veins by connective tissue and centrilobular necrosis in zone 3 of the acini. Occlusion of the terminal venules of the liver might result in HVOD with the characteristic clinical findings of painful hepatomegaly, ascites, jaundice, and weight gain for more than 5% of patients. It is mainly observed after hematopoietic stem cell transplantation (SCT) and is responsible for significant morbidity and mortality. The incidence of HVOD is much lower after solid organ transplantation than after SCT and seems to differ from one organ to another. It has been sporadically reported after lung, renal, and liver transplantation, but has never been reported after pancreas transplantation. In general, HVOD is presumably attributed to azathioprine or tacrolimus used in solid organ transplantation. Here we describe a case of HVOD occurring after pancreas transplantation, in which tacrolimus might have played a causative role because complete recovery was observed after discontinuation of tacrolimus. Pancreas transplantation physicians should raise the suspicion of HVOD when a recipient presents with hepatomegaly, ascites, or jaundice.

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Veno-Occlusive Hepatic Disease of the Liver in Renal Transplantation: Is Azathioprine the Cause?

Cited by 58 publications

References 15 publications

Azathioprine in dermatology: The past, the present, and the future

Azathioprine in dermatology: The past, the present, and the future

Transjugular intrahepatic portosystemic shunt for the treatment of sinusoidal obstruction syndrome in a liver transplant recipient and review of the literature

Hepatic veno-occlusive disease related to tacrolimus after pancreas transplantation

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