NODULAR REGENERATIVE HYPERPLASIA - A CONTROVERSIAL INDICATION FOR ORTHOTOPIC LIVER-TRANSPLANTATION

Nodular regenerative hyperplasia of the liver is an uncommon cause of portal hypertension. Patients with nodular regenerative hyperplasia ha ve signs and symptoms of portal hypertension, without evidence of hepa tocellular failure or encephalopathy. We report the case of a 44-year- old woman with recurrent esophageal bleeding and refractory ascites wh o had a history of hemosiderosis, hepatitis C, and chronic renal allog raft rejection. Our preoperative diagnosis was cirrhotic end-stage liv er disease and end-stage renal disease for which the patient underwent combined hepatic and renal transplantation. Her portal hypertension s ymptoms resolved, and her renal function has been normal for 18 months of follow-up. Histologic examination of the liver revealed nodular re generative hyperplasia, and a review of the literature regarding the s urgical management of patients with nodular regenerative hyperplasia r evealed that various shunting procedures are generally recommended. Af ter the failure of medical management in patients with nodular regener ative hyperplasia, portosystemic shunting may be indicated before proc eeding to hepatic transplantation.