title: Successful treatment of severe azathioprine-induced hepatic veno-occlusive disease in a kidney-transplanted patient with transjugular intrahepatic portosystemic shunt.
abstract: 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.
authors.affiliation: Centre Hépato-Biliaire, Faculté de Médecine Paris-Sud, France.
authors.forename: D
authors.initials: D
authors.lastname: Azoulay
authors.forename: D
authors.initials: D
authors.lastname: Castaing
authors.forename: A
authors.initials: A
authors.lastname: Lemoine
authors.forename: D
authors.initials: D
authors.lastname: Samuel
authors.forename: P
authors.initials: P
authors.lastname: Majno
authors.forename: M
authors.initials: M
authors.lastname: Reynes
authors.forename: B
authors.initials: B
authors.lastname: Charpentier
authors.forename: H
authors.initials: H
authors.lastname: Bismuth
mesh_terms: 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
chemical_list: D007166:Immunosuppressive Agents; D001379:Azathioprine