Hepatic veno-occlusive disease related to tacrolimus after pancreas transplantation

Abstract

Introduction: Hepatic veno-occlusive disease (HVOD) describes the nonthrombotic, fibrous obliteration of the small centrilobular hepatic veins by connective tissue and centrilobular necrosis in zone 3 of the acini. Materials: We describe a case of HVOD occurring after pancreas transplantation, in which tacrolimus might have played a causative role since complete recovery was observed after discontinuation of tacrolimus. Results: A 25-year-old female with NIDDM and uremia. She underwent SPK transplantation. Nine months after transplantation, she reported development of fever, mild right abdominal pain and an increase in abdominal girth. The CT scan showed pictures of HVOD with hepatomegaly, massive ascites, periportal edema, diffuse mottled hepatic enhancement and patent hepatic veins (Fig. 1b). The periportal edema and diffuse mottled hepatic enhancement, in addition to the signs of portal hypertension, might suggest sinusoidal stasis. Tacrolimus was discontinued and replaced by cyclosporine. Three months after discontinuing tacrolimus, there was resolution of the patient HVOD demonstrated by CT scan (Fig .1c). Conclusion: This is the first case of HVOD after pancreas transplantation in the literature. HVOD should be suspected when a recipient presents with hepatomegaly, ascites or jaundice after pancreas transplantation under tacrolimus.