Severe hypogammaglobulinemia associated with hepatic vein stenosis causes cytomegalovirus infection after living-related liver transplantation.

Abstract

Hepatic vein stenosis is a vascular complication that can lead to graft loss after liver transplantation. Although ascites frequently occurs as a symptom of hepatic vein stenosis, the development of severe hypogammaglobulinemia associated with hepatic vein stenosis has not been reported in the literature. An 8-year-old boy underwent living-related liver transplantation (LRLT) because of Wilson disease with chronic hepatic failure. Because de novo autoimmune hepatitis was diagnosed 1 year after LRLT, azathioprine, and prednisolone were added to the baseline immunosuppression of tacrolimus. The patient developed ascites with severe hypogammaglobulinemia (immunoglobulin G [IgG], 288 mg/dL) 2 years after LRLT. Ultrasonography and angiography disclosed stenosis of the hepatic vein. The ascites completely resolved after percutaneous balloon angioplasty. Despite serum IgG trough levels of >500 mg/dL maintained by the addition of immunoglobulin, cytomegalovirus reactivation and sepsis occurred. Serum IgG levels should be monitored to prevent opportunistic infections when hepatic vein stenosis is diagnosed after LRLT.

• Authors: H Komatsu, A Inui, T Sogo, T Fujisawa, H Egawa, K Tanaka
• Journal: Transplant infectious disease : an official journal of the Transplantation Society (Transpl Infect Dis) Vol. 7 Issue 1 Pg. 41-4 (Mar 2005) ISSN: 1398-2273 [Print] Denmark
• PMID: 15984949 (Publication Type: Case Reports, Journal Article)

Chemical References

• Immunoglobulins, Intravenous

Topics

• Agammaglobulinemia (etiology)
• Ascites (etiology, immunology)
• Child
• Constriction, Pathologic (etiology, immunology)
• Cytomegalovirus Infections (drug therapy, immunology)
• Hepatic Veins
• Humans
• Immunoglobulins, Intravenous (therapeutic use)
• Liver Transplantation (adverse effects)
• Male
• Opportunistic Infections