Post–Liver Transplantation Sinusoidal Obstruction Syndrome With Refractory Ascites Induced by Mycophenolate Mofetil

Hepatology ◽  
2020 ◽  
Vol 71 (4) ◽  
pp. 1508-1510 ◽  
Author(s):  
Edoardo Poli ◽  
Ilias Kounis ◽  
Catherine Guettier ◽  
Céline Verstuyft ◽  
Audrey Coilly ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Mycophenolate Mofetil ◽  
Refractory Ascites ◽  
Sinusoidal Obstruction Syndrome

scholarly journals Transsplenic portal vein recanalization and direct intrahepatic portosystemic shunt placement to optimize liver transplantation

2020 ◽  
Vol 3 (1) ◽  
Author(s):  
Osman Ahmed ◽  
Abhijit L. Salaskar ◽  
Steven Zangan ◽  
Anjana Pillai ◽  
Talia Baker
Keyword(s):  
Liver Transplantation ◽  
Portal Vein ◽  
Splenic Vein ◽  
Portosystemic Shunt ◽  
Refractory Ascites ◽  
Hepatic Veins ◽  
Sonographic Guidance ◽  
Portosystemic Shunts ◽  
Intrahepatic Portosystemic Shunt ◽  
End To End

Abstract Background Percutaneous trans-splenic portal vein recanalization (PVR) has been reported for facilitation of transjugular intrahepatic portosystemic shunts (TIPS), however has not been applied to patients undergoing direct intrahepatic portosystemic shunt (DIPS). We report the utilization of trans-splenic-PVR with DIPS creation in a patient with chronic portal and hepatic vein occlusions undergoing liver transplantation evaluation. Case presentation A 48-year-old male with decompensated alcoholic cirrhosis complicated by refractory ascites, hepatic encephalopathy, and variceal bleeding underwent CT that demonstrated chronic occlusion of the hepatic veins (HV), extrahepatic portal vein (PV), and superior mesenteric vein (SMV). Due to failed attempts at TIPS at outside institutions, interventional radiology was consulted for portal vein recanalization (PVR) with TIPS to treat the portal hypertension and ascites and also facilitate an end-to-end PV anastomosis at transplantation. After an initial hepatic venogram confirmed chronic HV occlusion, a DIPS with trans-splenic PVR was planned. The splenic vein was accessed under sonographic guidance using a micropuncture set and subsequently upsized to a 6 French sheath over a stiff guidewire. A splenic venogram via this access confirmed occlusion of the PV with drainage of the splenic vein (SV) through gastric varices. The thrombosed PV was then recanalized and angioplastied to restore PV flow via the transsplenic approach. A transjugular liver access kit with a modified 21-gauge needle was advanced into the IVC through the internal jugular vein (IJV) sheath and directed towards the target snare in PV. The needle was used to subsequently puncture the PV through the caudate lobe and facilitate placement of a wire into the SV. The initial portosystemic gradient (PSG) was 20 mmHg. The IJV sheath was advanced through the hepatic parenchymal tract into the main-PV and a stent-graft was placed across the main PV and into the IVC. A portal venogram demonstrated brisk blood flow through the DIPS, resolution of varices and a PSG of 8 mmHg. One month after the procedure, the patient had a significant reduction in ascites and MELD-NA score. Patient is currently listed and awaiting transplantation. Conclusions In the setting of chronically occluded portal and hepatic veins, trans-splenic PVR DIPS may serve as an effective bridge to liver transplantation by facilitating an end to end portal vein anastomosis.

Mycophenolate Mofetil, HCV and liver transplantation

2002 ◽  
Vol 36 ◽  
pp. 190
Author(s):  
Guilherme Macedo ◽  
J.Costa Maia ◽  
Abilio Gomes ◽  
Angelo Ferreira ◽  
Miguel Campos ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Mycophenolate Mofetil

Acquired Pelger-Huët Anomaly in Association With Concomitant Tacrolimus and Mycophenolate Mofetil in a Liver Transplant Patient: A Case Report and Review of the Literature

2006 ◽  
Vol 130 (1) ◽  
pp. 93-96
Author(s):  
Joan E. Etzell ◽  
Endi Wang
Keyword(s):  
Liver Transplantation ◽  
Mycophenolate Mofetil ◽  
Case Report ◽  
Transplant Patient ◽  
Immunosuppressive Agents ◽  
Single Agent ◽  
Review Of The Literature ◽  
Liver Transplant Patient ◽  
Underlying Causes ◽  
Nuclear Segmentation

Abstract Pelger-Huët anomaly is a congenital or acquired abnormality of neutrophil nuclear segmentation. The acquired form may be a result of a clonal myeloid malignancy, such as myelodysplastic syndrome, or may be a secondary nonclonal change related to a variety of underlying causes, including infections and medications. We report a case of a 56-year-old man who developed acquired Pelger-Huët anomaly following liver transplantation while on the immunosuppressive agents tacrolimus and mycophenolate mofetil. These medications have been reported in association with this abnormality, but usually as a single agent or in combination with other drugs. In our case, the Pelger-Huët anomaly may be the result of the combination of these 2 drugs or mycophenolate alone with subsequent desensitization because resolution of the abnormality occurred after a reduction in mycophenolate mofetil dose, and the abnormality did not recur when mycophenolate mofetil was increased to a dose previously associated with Pelger-Huët anomaly during the time that tacrolimus was discontinued.

scholarly journals Impact of cardiac function, refractory ascites and beta blockers on the outcome of patients with cirrhosis listed for liver transplantation

2020 ◽  
Vol 72 (3) ◽  
pp. 463-471 ◽  
Author(s):  
Valerio Giannelli ◽  
Olivier Roux ◽  
Cédric Laouénan ◽  
Pauline Manchon ◽  
Floriane Ausloos ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Cardiac Function ◽  
Beta Blockers ◽  
Refractory Ascites

A NOVEL MANAGEMENT STRATEGY OF STEROID-FREE IMMUNOSUPPRESSION AFTER LIVER TRANSPLANTATION: EFFICACY AND SAFETY OF TACROLIMUS AND MYCOPHENOLATE MOFETIL

2001 ◽  
Vol 71 (4) ◽  
pp. 508-515 ◽  
Author(s):  
Burckhardt Ringe ◽  
Felix Braun ◽  
Ekkehard Sch??tz ◽  
Lazlo F??zesi ◽  
Thomas Lorf ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Mycophenolate Mofetil ◽  
Management Strategy ◽  
Efficacy And Safety

Letter to the Editor: Post‐Liver Transplantation Sinusoidal Obstruction Syndrome and immunosuppressive drugs: causality of MMF or tacrolimus?

Hepatology ◽  
2020 ◽  
Author(s):  
Véronique Loustaud‐Ratti ◽  
Alicia Anneraud ◽  
Paul Carrier ◽  
Marilyne Debette‐Gratien ◽  
Anne De Muret ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Immunosuppressive Drugs ◽  
Sinusoidal Obstruction Syndrome ◽  
Letter To The Editor
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