TY - JOUR
T1 - Significance of nodular regenerative hyperplasia occurring de novo following liver transplantation
AU - Devarbhavi, Harshad
AU - Abraham, Susan
AU - Kamath, Patrick S.
PY - 2007/11
Y1 - 2007/11
N2 - Nodular regenerative hyperplasia (NRH) of the liver usually occurs in patients with rheumatological and myelolymphoproliferative disorders; the occurrence post-liver transplantation (LT) has traditionally been ascribed to the use of azathioprine. We report the clinical, biochemical, and radiological features of 14 patients who developed NRH, unrelated to azathioprine in most cases, 3 months to 11 yr after orthotopic LT. A total of 10 patients developed NRH within 4 yr (early onset), and 4 other patients developed the condition beyond 4 yr of LT (late onset). A total of 7 symptomatic patients, all in the early group, had features of portal hypertension with vascular abnormalities on Doppler ultrasonography that were preceded by the diagnosis of NRH. All asymptomatic patients, including each of the 4 patients in the late group, had normal hepatic ultrasound (US) studies. Two symptomatic patients had normalization of histologic abnormalities after correction of vascular abnormalities. In conclusion, observation is appropriate for patients who develop NRH late following LT. Patients in whom NRH is detected on liver biopsy early after transplantation are likely to develop portal hypertension in the future. Interven imed at correcting the vascular abnormalities in these patients may result in clinical as well as hepatic histological improvement.
AB - Nodular regenerative hyperplasia (NRH) of the liver usually occurs in patients with rheumatological and myelolymphoproliferative disorders; the occurrence post-liver transplantation (LT) has traditionally been ascribed to the use of azathioprine. We report the clinical, biochemical, and radiological features of 14 patients who developed NRH, unrelated to azathioprine in most cases, 3 months to 11 yr after orthotopic LT. A total of 10 patients developed NRH within 4 yr (early onset), and 4 other patients developed the condition beyond 4 yr of LT (late onset). A total of 7 symptomatic patients, all in the early group, had features of portal hypertension with vascular abnormalities on Doppler ultrasonography that were preceded by the diagnosis of NRH. All asymptomatic patients, including each of the 4 patients in the late group, had normal hepatic ultrasound (US) studies. Two symptomatic patients had normalization of histologic abnormalities after correction of vascular abnormalities. In conclusion, observation is appropriate for patients who develop NRH late following LT. Patients in whom NRH is detected on liver biopsy early after transplantation are likely to develop portal hypertension in the future. Interven imed at correcting the vascular abnormalities in these patients may result in clinical as well as hepatic histological improvement.
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U2 - 10.1002/lt.21142
DO - 10.1002/lt.21142
M3 - Article
C2 - 17969192
AN - SCOPUS:36448991940
SN - 1527-6465
VL - 13
SP - 1552
EP - 1556
JO - Liver Transplantation
JF - Liver Transplantation
IS - 11
ER -