IDIOPATHIC PORTAL-HYPERTENSION IN RENAL-TRANSPLANT RECIPIENTS - REPORT OF 2 CASES

We present herein the cases of two patients who developed idiopathic p ortal hypertension (IPH) following renal transplantation. Both patient s had been treated with azathioprine and prednisolone for 6 years and 4 months and for 4 years and 7 months, respectively, and presented wit h splenomegaly and thrombocytopenia suggesting hypersplenism. Celiac a ngiography showed a dilated splenic artery and vein in both patients. When the splenic artery was obliterated with a balloon catheter in cas e I, the portal venous pressure decreased from 51 cmH(2)O to 36 cmH(2) O, and the direction of the superiomesenteric venous blood flow became hepatopetal rather than hepatofugal. These results suggested that the spleen might have played an important role in the development of IPH in these two patients. A splenectomy was therefore performed, immediat ely following which the portal venous pressure decreased remarkably, a nd the esophageal varices disappeared during the postoperative follow- up period. Microscopic examination of liver biopsies taken at the oper ation revealed lymphoplasmacytic infiltration with bile duct hyperplas ia but no evidence of periportal fibrosis, and electron microscopy dem onstrated very mild perisinusoidal fibrosis. Thus, the histological ch anges seen in the livers of these patients seemed not to have caused t he portal hypertension. In conclusion, although few patients develop I PH after renal transplantation, we should be aware of its possibility and consider splenectomy as the treatment of choice.