Management of hepatic vein occlusive disease after liver transplantation: A case report with literature review

Abstract

Rationale: 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%.

Patient concerns: 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.

Diagnoses: Imagining and pathology showed no evidence of rejection or vessels complications. HVOD was diagnosed with pathology biopsy.

Interventions: Tacrolimus was withdrawn and the progression of HVOD was reversed.

Outcomes: Now, this patient has been followed up for 6 months after discharge with normal liver graft function.

Lessons: 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.

Figure 1

A 59-year-old male underwent liver transplantation. Hepatic hemodynamics at POD 11 were normal. (A) The large vessels in liver were unobstructed. (B) The blood flow returned to normal at POD 160.

Figure 2

The CT results of this patient. (A) The uneven reduction of hepatic density and there is no blood flow in hepatic vein and their branches. We withdrew tacrolimus after confirming the diagnosis of HVOD and the development of HVOD was reversed rapidly. (B) The redevelopment of hepatic vein.

Figure 3

The histologic results of this patient. (A) The central venous sinusoidal expansion around the regional congestion and atrophy or dissolved of liver cells. That can confirm the diagnosis of HVOD. (B) The normal structure of donor liver under the microscope after operation. The graft liver did not have HVOD before liver transplantation.