Multiple hepatic nodules in a renal transplant recipient

Area of Science:

• Nephrology
• Hepatology
• Transplantation Medicine

Background:

• A 55-year-old female underwent a cadaveric renal transplant in 2003.
• Routine follow-up revealed multiple liver nodules 16 months post-transplant.

Observation:

• Serial imaging studies were negative for malignancy.
• The patient was on a quadruple immunosuppressive regimen including prednisolone, cyclosporine, mycophenolate mofetil, and sirolimus.
• Elevated serum ferritin levels (1,466 ng/ml) and fatty metamorphosis were noted on liver biopsies, with no evidence of tumor.

Findings:

• Despite initial concern, the liver nodules gradually disappeared over 3 years.
• The nodules regressed as immunosuppressive medications (cyclosporine, sirolimus, corticosteroids) were tapered.
• Serum ferritin levels also declined to 600-800 ng/ml.

Implications:

• This case suggests that liver nodules in transplant recipients can be associated with immunosuppression and high ferritin levels, mimicking malignancy.
• Careful monitoring and potential reduction of immunosuppressive therapy may lead to resolution of such lesions.
• Highlights the importance of considering non-neoplastic causes for liver lesions in immunocompromised patients.