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Hepatic veno-occlusive disease due to tacrolimus in a single-lung transplant patient

¹ Depts of Pulmonary, Allergy and Critical Care, and ² Gastroenterology and Hepatology, Cleveland Clinic Foundation, Cleveland, OH, USA.

CORRESPONDENCE: M. Budev, Dept of Pulmonary, Allergy and Critical Care, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA. Fax: 1 2164458160. E-mail: Budevm{at}ccf.org

Keywords: Lung transplantation, tacrolimus, veno-occlusive disease

Received: April 21, 2005
Accepted October 3, 2005

Hepatic veno-occlusive disease is defined as nonthrombotic fibrous obliterative endophlebitis of small centrilobular hepatic venules.

Clinically, patients present with elevated liver enzymes and a triad of jaundice, hepatomegaly and ascites. Although reported as a complication of other solid organ and stem cell transplantation, there have been no reported cases to date of veno-occlusive disease following lung transplantation.

The present authors report a case of veno-occlusive disease following single-lung transplantation in a patient on a triple-drug immunosuppressive regimen composed of tacrolimus, mycophenolate mofetil and prednisone.

The diagnosis was established by transjugular liver biopsy and by discontinuing tacrolimus; there was clinical regression of symptoms and serological return to baseline.