LIVER TRANSPLANT AN UNCOMMON CAUSE OF ESOPHAGEAL VARICES

Abstract

Esophageal varices are commonly associated with portal hypertension secondary to liver cirrhosis. The shortage of liver donors has fostered the institution of living-donor transplantation (LDT). The risks of LDT has not been systematically collected or reported since the first donor in 1989. However, the available evidence suggests that right hepatic lobe donation appears to be safe. To date there has been no report of esophageal varices occurring due to LDT in the donor. We report the first case of a patient without liver disease who underwent a LDT who subsequently developed esophageal varices. Pt is a 55yo female referred to the Gastroenterology Clinic for anemia and occult positive stools. Pt was on high dose naproxen sodium for a sprained ankle and presented to the ER with lightheadedness. She was tilt negative, lavage negative, denied history of peptic ulcer disease, hematemesis, me-lena, hematochezia, abdominal pain, previous esophagogastroduodenoscopy (EGD) and colonoscopy. Pt was noted to be anemic with a hematocrit of 23.9 (baseline 38). She was instructed to stop her naproxen sodium, discharged on iron pills and colace, and given a Gastroenterology consult. Pt had no other past medical history. Surgical history was significant for being a LDT of the right lobe in Jun01. She was a non-smoker and non-drinker. She had no history of hepatitis or cirrhosis. Family history was non-contributory. A month later she was evaluated by Gastroenterology. Initial laboratories to include a complete blood count, liver associated enzymes, basic chemistry panel, and coagulation panel were normal. Pt underwent a colonoscopy and EGD. The colonoscopy was normal. The EGD revealed three columns of Grade II esophageal varices without any stigmata of recent bleed and portal-hypertensive gastropathy. There were no gastric varices. A computerized tomographic (CT) scan of the liver revealed a regenerated liver with a volume of 1092 cc. and carvernous transformation of the portal vein with filling defects in the collaterals representing thrombosis. Esophageal varices have not been previously reported as a complication of LDT. The most common perioperative complications include infection, hepatic arterial thrombosis, biliary strictures, and bleeding complications. Mortality rate of the donor has been calculated at 0.2%. The long-term complications have mainly included quality-of-life issues for the donor that includes body image and abdominal discomfort. Generally LDT is considered to be safe and without serious long-term sequelae.