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: D Azoulay, D Castaing, A Lemoine, D Samuel, P Majno, M Reynes, B Charpentier, H Bismuth
• Journal: Clinical nephrology (Clin Nephrol) Vol. 50 Issue 2 Pg. 118-22 (Aug 1998) ISSN: 0301-0430 [Print] Germany
• PMID: 9725784 (Publication Type: Case Reports, Journal Article, Review)

Chemical References

• Immunosuppressive Agents
• Azathioprine

Topics

• Adult
• Azathioprine (adverse effects, therapeutic use)
• Biopsy
• Hepatic Veno-Occlusive Disease (chemically induced, pathology, surgery)
• Humans
• Immunosuppression Therapy
• Immunosuppressive Agents (adverse effects, therapeutic use)
• Kidney Transplantation
• Liver (pathology)
• Male
• Portasystemic Shunt, Transjugular Intrahepatic