Successful treatment of severe azathioprine-induced hepatic veno-occlusive disease in a kidney-transplanted patient with transjugular intrahepatic portosystemic shunt.
Azathioprine-induced veno-occlusive disease of the liver mainly described after kidney transplantation is as rare as severe with a high mortality due to acute portal hypertension and liver failure. A kidney-transplanted patient with severe azathioprine-induced veno-occlusive disease of the liver and worsening despite drug discontinuation was treated by emergency transjugular intrahepatic portosystemic shunt. Whereas the veno-occlusive disease was controlled, the patient developed severe intractable portosystemic encephalopathy successfully treated by a stent reducer maintaining a certain degree of portal diversion. Twelve months after transjugular intrahepatic portosystemic shunt, liver function was normalized and the stent was thrombosed with a subnormal liver histology. Thirty-six months after transjugular intrahepatic portosystemic shunt the patient is alive with normal liver function tests and kidney graft function. Transjugular intrahepatic portosystemic shunt for treatment of severe veno-occlusive disease of the liver is an alternative to tide the patient over until recovery of liver function.
Azoulay
D
D
Centre Hépato-Biliaire, Faculté de Médecine Paris-Sud, France.
Castaing
D
D
Lemoine
A
A
Samuel
D
D
Majno
P
P
Reynes
M
M
Charpentier
B
B
Bismuth
H
H
D000328:Adult; D001379:Azathioprine / Q000009:adverse effects* / Q000627:therapeutic use; D001706:Biopsy; D006504:Hepatic Veno-Occlusive Disease / Q000139:chemically induced* / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007165:Immunosuppression Therapy; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D016030:Kidney Transplantation; D008099:Liver / Q000473:pathology; D008297:Male; D019168:Portasystemic Shunt, Transjugular Intrahepatic
D007166:Immunosuppressive Agents; D001379:Azathioprine