Repeated detection of gas in the portal vein after liver transplantation: A sign of EBV-associated post-transplant lymphoproliferation?
A 1-yr-old child presented with intractable right sided pleural effusion and progressive clinical deterioration 3 weeks after liver transplantation for Alagille Syndrome. He had been treated successfully for severe acute rejection before. Ultrasound and Doppler mode studies repeatedly demonstrated air in the portal vein. Intra-abdominal and intra-thoracic lymphoproliferation was detected, and EBV virus load and serology were suggestive of primary EBV infection. Liver biopsy revealed blast-like infiltrates of B-cells, considered diagnostic for post-transplant lymphoproliferative disease. The disease resolved upon reduction of immunosuppression. We suggest that the detection of portal vein gas in pediatric liver transplant recipients beyond the early post-operative period may be a sign of intra-abdominal post-transplant lymphoproliferative disease.
Wallot
Michael A
MA
Department of Pediatrics, Universitätsklinikum Essen, Hufelandstr.55, 45122 Essen, Germany. michael.wallot@uni-essen.de
Klepper
Jörg
J
Clapuyt
Philippe
P
Dirsch
Olaf
O
Malagó
Max
M
Reding
Raymond
R
Otte
Jean Bernard
JB
Sokal
Etienne M
EM
D016738:Alagille Syndrome / Q000601:surgery; D003937:Diagnosis, Differential; D020031:Epstein-Barr Virus Infections / Q000175:diagnosis*; D004854:Herpesvirus 4, Human / Q000302:isolation & purification; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D007223:Infant; D016031:Liver Transplantation; D008232:Lymphoproliferative Disorders / Q000175:diagnosis* / Q000821:virology*; D008297:Male; D011169:Portal Vein / Q000000981:diagnostic imaging*; D013771:Tetralogy of Fallot / Q000601:surgery; D018608:Ultrasonography, Doppler
D007166:Immunosuppressive Agents