Hou Yuchen, Tam Nga Lei, Xue Zhicheng, Zhang Xuzhi, Liao Bing, Yang Jie, Fu Shunjun, Ma Yi, Wu Linwei, He Xiaoshun
Department of Organ Transplantation Department of Pathology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
Medicine (Baltimore). 2018 Jun;97(24):e11076. doi: 10.1097/MD.0000000000011076.
Hepatic vein occlusive disease (HVOD) is a rare complication after liver transplantation, which is characterized by nonthrombotic, fibrous obliteration of the small centrilobular hepatic veins by connective tissue and centrilobular necrosis in zone 3 of the acini. HVOD after solid organ transplantation has been reported; recently, most of these reports with limited cases have documented that acute cell rejection and immunosuppressive agents are the major causative factors. HVOD is relatively a rare complication of liver transplantation with the incidence of approximately 2%.
A 59-year-old male patient with alcoholic liver cirrhosis underwent liver transplantation in our center. He suffered ascites, renal impairment 3 months after the surgery while liver enzymes were in normal range.
Imagining and pathology showed no evidence of rejection or vessels complications. HVOD was diagnosed with pathology biopsy.
Tacrolimus was withdrawn and the progression of HVOD was reversed.
Now, this patient has been followed up for 6 months after discharge with normal liver graft function.
The use of tacrolimus in patients after liver transplantation may cause HVOD. Patients with jaundice, body weight gain, and refractory ascites should be strongly suspected of tacrolimus related HVOD.
肝静脉闭塞病（HVOD）是肝移植后一种罕见的并发症，其特征是小叶中央小肝静脉被结缔组织非血栓性纤维闭塞，以及腺泡3区的小叶中央坏死。实体器官移植后发生HVOD已有报道；最近，这些病例有限的大多数报告表明，急性细胞排斥反应和免疫抑制剂是主要致病因素。HVOD相对而言是肝移植中一种罕见的并发症，发病率约为2%。
一名59岁的酒精性肝硬化男性患者在我们中心接受了肝移植。术后3个月，他出现腹水、肾功能损害，而肝酶在正常范围内。
影像学和病理学检查均未发现排斥反应或血管并发症的证据。通过病理活检诊断为HVOD。
停用他克莫司，HVOD的进展得到逆转。
现在，该患者出院后已随访6个月，移植肝功能正常。
肝移植后患者使用他克莫司可能导致HVOD。出现黄疸、体重增加和难治性腹水的患者应高度怀疑与他克莫司相关的HVOD。
