Hepatic veno-occlusive disease related to tacrolimus after pancreas transplantation
Hepatic veno-occlusive disease related to tacrolimus after pancreas transplantation
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DOI：
10.1016/j.jcma.2013.03.001
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发表时间：
2013-06-01
影响因子：
3
通讯作者：
Lee, Rheun-Chuan
中科院分区：
文献类型：
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作者：
Wang, Shin-E;Shyr, Yi-Ming;Lee, Rheun-Chuan
肝静脉闭塞病(HVOD)描述小叶中心小静脉被结缔组织和腺泡3区小叶中心坏死所致的非血栓形成的纤维性闭塞。肝终末小静脉闭塞可导致HVOD，超过5%的患者具有肝肿大、腹水、黄疸和体重增加的典型临床表现。它主要是在造血干细胞移植(SCT)后观察到的，并与显著的发病率和死亡率有关。实质器官移植后HVOD的发生率比SCT后低得多，而且似乎在不同的器官之间有所不同。在肺、肾和肝移植后曾有零星报道，但在胰腺移植后从未报道过。一般来说，HVOD可能归因于在实体器官移植中使用硫唑嘌呤或他克莫司。在这里，我们描述了一例胰腺移植后发生的HVOD，他克莫司可能在其中起了致病作用，因为在他克莫司停药后观察到完全恢复。当受者出现肝肿大、腹水或黄疸时，胰腺移植医生应提高对HVOD的怀疑。版权所有(C)2013爱思唯尔台湾有限责任公司和中华医学会。版权所有。
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. Occlusion of the terminal venules of the liver might result in HVOD with the characteristic clinical findings of painful hepatomegaly, ascites, jaundice, and weight gain for more than 5% of patients. It is mainly observed after hematopoietic stem cell transplantation (SCT) and is responsible for significant morbidity and mortality. The incidence of HVOD is much lower after solid organ transplantation than after SCT and seems to differ from one organ to another. It has been sporadically reported after lung, renal, and liver transplantation, but has never been reported after pancreas transplantation. In general, HVOD is presumably attributed to azathioprine or tacrolimus used in solid organ transplantation. Here we describe a case of HVOD occurring after pancreas transplantation, in which tacrolimus might have played a causative role because complete recovery was observed after discontinuation of tacrolimus. Pancreas transplantation physicians should raise the suspicion of HVOD when a recipient presents with hepatomegaly, ascites, or jaundice. Copyright (C) 2013 Elsevier Taiwan LLC and the Chinese Medical Association. All rights reserved.