Centrilobular necrosis as a manifestation of venous outflow block in pediatric malnourished liver transplant recipients--case reports.
CLN is a frequent histological finding in biopsies after pediatric: LT, and its pathogenesis has not yet been fully clarified and has different causes. Among the vascular causes, VOB is sometimes difficult to diagnose, especially when technical variants such as split-liver, reduced-liver, or living-related LT are utilized. Three liver-transplanted malnourished children (ages 12, 20, and 28 months) developed altered LFTs and post-operative ascites with right pleural effusion (two cases) and jaundice (one case). Doppler ultrasound examinations were normal and liver biopsies showed CLN interpreted as severe ACR. There were no responses to the medical treatment. Additional investigation with CT angiography suggested obstructed hepatic vein drainage, which was confirmed by interventional radiology and angioplasty of the anastomosis between the hepatic vein and the inferior vena cava, with clinical and histological resolution. It is concluded that in malnourished children undergoing LT with technical variations, in which the occurrence of severe ACR is usually less common because of the severity of the patient condition, the finding of CLN should raise the possibility of VOB, so that excessive immunosuppression and its consequences can be avoided.
Division of Pediatric Surgery and Liver Transplantation, University of Sao Paulo Medical School, Sao Paulo, Brazil.
Nelson E M
NE
Gibelli
Ana Cristina A
AC
Tannuri
Wagner C
WC
Andrade
Luiz Roberto S
LR
Ricardi
Uenis
U
Tannuri
D016738:Alagille Syndrome / Q000628:therapy; D000714:Anastomosis, Surgical; D001706:Biopsy; D002675:Child, Preschool; D005260:Female; D006084:Graft Rejection; D006503:Hepatic Veins / Q000473:pathology*; D006801:Humans; D007223:Infant; D008099:Liver / Q000473:pathology; D008107:Liver Diseases / Q000175:diagnosis*; D016031:Liver Transplantation / Q000379:methods; D019520:Living Donors; D008297:Male; D044342:Malnutrition / Q000150:complications*; D009336:Necrosis; D014057:Tomography, X-Ray Computed / Q000379:methods; D018608:Ultrasonography, Doppler / Q000379:methods; D014682:Vena Cava, Inferior / Q000473:pathology