LAPAROSCOPIC STUDY OF PELIOSIS HEPATIS AND NODULAR TRANSFORMATION OF THE LIVER BEFORE AND AFTER RENAL-TRANSPLANTATION - NATURAL-HISTORY ANDETIOLOGY IN FOLLOW-UP CASES

Although peliosis hepatis and nodular transformation of the liver can occur after renal transplantation, their prevalence has not been well defined. To investigate the incidence of these complications, 137 lapa roscopies were studied, 52 in 50 cases before and 85 in 66 cases after renal transplantation. To elucidate the aetiology and natural history of these diseases, cases were followed up by repeated laparoscopies. Peliosis was observed after transplantation (before: n=1, after: n=15 [22%], p<0.005). Nodular transformation was seen only after transplant ation (n=5 [7%]), and was accompanied by peliosis (n=4, p<0.01). On ob servation before and after transplantation in the same cases, these di seases appeared after transplantation (peliosis: n=9, p<0.005; nodular transformation: n=2). In follow-up cases, these diseases were confirm ed after the discontinuation of or the controlled administration of im munosuppressants. The aetiology of the micronodular transformation whi ch appeared following peliosis in a case treated without cyclosporin w as shown to be azathioprine. However, the macronodular transformation observed in two cases treated with both azathioprine and cyclosporin s eemed to be due to cyclosporin. This suggests that cases of peliosis h epatis and nodular transformation which appear after renal transplanta tion are associated with immunosuppressants, and that cyclosporin trea tment may also affect the morphogenesis of nodular transformation. (C) Journal of Hepatology.