title: Successful Living-Donor Liver Transplantation for Cholestatic Liver Failure Induced by Allopurinol: Case Report.
abstract: A 39-year-old man was diagnosed with allopurinol-induced hepatic injury. He did not show any sign of hepatic encephalopathy, but his serum total bilirubin level was >40 mg/dL when he visited the local hospital. The therapeutic effects of initial medical treatments were transient, and both renal function and coagulation ability were gradually deteriorated. Four months after the onset of hepatic injury, he was referred to our hospital for the purpose of liver transplantation (LT). Although he was wasting and severely jaundiced, his consciousness level was not disturbed at all, with normal serum ammonia blood concentration before LT. Owing to allopurinol-induced severe cholestatic liver failure, living-donor LT (LDLT) was performed with the use of a right lobe graft from his younger brother. The explanted liver was extremely enlarged, with a weight of 2,480 g, and severely cholestatic. Microscopic findings were also compatible with drug-induced cholestatic liver injury. He was discharged from hospital 55 days after LDLT, whereas his renal dysfunction remained at 6 months after LT. There are 3 types of pathophysiology of drug-induced hepatotoxicity: hepatocellular, cholestatic, and mixed liver injury. Although allopurinol hepatotoxicity is rare, it can be severe and even fatal. This is the 1st case report of successful LDLT for a patient who had developed allopurinol-induced cholestatic liver failure.
authors.affiliation: Department of Transplantation Surgery, Nagoya University School of Medicine, Nagoya, Japan. Electronic address: himai@med.nagoya-u.ac.jp.
authors.forename: H
authors.initials: H
authors.lastname: Imai
authors.affiliation: Department of Transplantation Surgery, Nagoya University School of Medicine, Nagoya, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Kamei
authors.affiliation: Department of Transplantation Surgery, Nagoya University School of Medicine, Nagoya, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Onishi
authors.affiliation: Department of Gastroenterology and Hepatology, Nagoya University School of Medicine, Nagoya, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Yamada
authors.affiliation: Department of Gastroenterology and Hepatology, Nagoya University School of Medicine, Nagoya, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Ishizu
authors.affiliation: Department of Gastroenterology and Hepatology, Nagoya University School of Medicine, Nagoya, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Ishigami
authors.affiliation: Department of Gastroenterology and Hepatology, Nagoya University School of Medicine, Nagoya, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Goto
authors.affiliation: Department of Transplantation Surgery, Nagoya University School of Medicine, Nagoya, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Ogura
mesh_terms: D000328:Adult; D000493:Allopurinol / Q000009:adverse effects*; D000963:Antimetabolites / Q000009:adverse effects*; D001663:Bilirubin / Q000097:blood; D056486:Chemical and Drug Induced Liver Injury / Q000209:etiology / Q000601:surgery*; D002779:Cholestasis / Q000139:chemically induced / Q000601:surgery*; D016166:Free Radical Scavengers / Q000009:adverse effects; D006801:Humans; D033461:Hyperuricemia / Q000188:drug therapy; D008111:Liver Function Tests; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors; D008297:Male
chemical_list: D000963:Antimetabolites; D016166:Free Radical Scavengers; D000493:Allopurinol; D001663:Bilirubin