A case of idiopathic portal hypertension after renal transplantation |
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Authors: | Nobuyoshi Yanagisawa MD Hitoshi Sugaya Kazuhiro Yunomura Takashi Harada Tohru Hisauchi |
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Institution: | 1. Division of Gastroenterology, JR General Hospital, 2-1-3 Yoyogi, Shibuyaku, 151, Tokyo, Japan 2. Second Department of Internal Medicine, Dokkyo University School of Medicine, 321-02, Tochigi, Japan 3. Department of Health Care, Dokkyo University School of Medicine, 321-02, Tochigi, Japan
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Abstract: | A case of idiopathic portal hypertension (IPH) developing after renal transplantation is reported. A 33-year-old Japanese
male who had undergone renal transplantation 8 years previously was transferred to our hospital because of hematemesis from
ruptured esophageal varices. He had no history of any liver disease before the renal transplantation, but had a history of
receiving blood transfusion. Abdominal computed tomography (CT) and ultrasonography revealed marked splenomegaly and collateral
channels, but no obliteration which might cause portal hypertension in the hepatic or portal vein. No findings suggestive
of hepatitis or liver cirrhosis were found either macroscopically on laparoscopy or by liver biopsy. Light microscopic study
of the liver biopsy specimen showed mild periportal fibrosis, inconspicuous portal branches in the most peripheral tracts,
but no pseudolobule formation or piecemeal necrosis. However collagen deposition was found in the perisinusoidal space and
partly in intercellular space on electron microscopy. We consider that the development of portal hypertension in this case
is responsible for the collagen deposition, which may be related to the administration of azathioprine after renal transplantation.
There are few reports on IPH after renal transplantation, and it is stressed that a lower amount of azathioprine than previously
reported may induce IPH under such conditions. |
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Keywords: | azathioprine renal transplantation idiopathic portal hypertension (IPH) |
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