Hepatic veno-occlusive disease related to tacrolimus after pancreas transplantation

Area of Science:

• Hepatology
• Transplantation Medicine
• Clinical Pharmacology

Background:

• Hepatic veno-occlusive disease (HVOD) is a serious complication, primarily seen after hematopoietic stem cell transplantation.
• HVOD involves the fibrous obliteration of hepatic venules, leading to hepatomegaly, ascites, and jaundice.
• While reported after some solid organ transplants, HVOD is notably absent in prior pancreas transplantation literature.

Observation:

• A case of HVOD is described following pancreas transplantation.
• The patient presented with classic HVOD symptoms including painful hepatomegaly, ascites, and jaundice.
• Azathioprine and tacrolimus were administered as part of the immunosuppressive regimen.

Findings:

• Complete recovery from HVOD was observed after discontinuation of tacrolimus.
• This suggests a potential causative role for tacrolimus in the development of HVOD post-pancreas transplantation.
• The findings challenge the previously assumed absence of HVOD after pancreas transplantation.

Implications:

• Pancreas transplant physicians should consider HVOD in recipients presenting with hepatomegaly, ascites, or jaundice.
• Tacrolimus should be evaluated as a potential culprit in drug-induced HVOD.
• Early recognition and management, including drug withdrawal, may improve patient outcomes.