Intrahepatic cholestasis due to azathioprine.

Severe intrahepatic cholestasis occurred 13 months following renal homotransplantation in a patient treated with azathioprine and prednisone. The patient had not received other drugs, surgery, anesthesia, or blood transfusions since transplantation. Extrahepatic biliary obstruction was excluded by laparotomy and operative cholangiography. Histologically, marked cholestasis was present with minimal necrosis and inflammation terminally. An awareness of this possible complication is important in the treatment of chronic liver disease with azathioprine.