IMPACT AND EVOLUTION OF PELIOSIS HEPATIS IN RENAL-TRANSPLANT RECIPIENTS

Peliosis hepatis and hepatic sinusoidal dilatations are rare vascular liver diseases that occur at increased frequency in kidney transplant recipients. We retrospectively evaluated in kidney transplant recipien ts the natural history of vascular liver diseases, their impact on pat ient and graft survival, and the influence of AZA withdrawal. Between 1970 and 1990, vascular liver disease was diagnosed in 32 cadaver kidn ey transplant recipients 1-128 months after transplantation (mean 41 m onths). Diagnosis was based on histology in all cases. Patients receiv ed conventional immunosuppression (high dose steroids and AZA). Twenty patients had a minor form (sinusoidal dilatations or focal peliosis), while 12 had a major form (diffuse peliosis) of vascular hepatic dise ase. Two patients were lost to follow-up and 1 died at the time of dia gnosis. In 12 patients (group 1), AZA dosage remained unchanged, while it was interrupted at the time of diagnosis in 17 patients (group 2). Five group 1 patients underwent serial liver biopsies, which showed p ersistence of vascular hepatic disease in 3 (with regenerative nodular hyperplasia in 1) and disappearance in 2 patients. Eight group 2 pati ents underwent serial liver biopsies, which showed disappearance of va scular hepatic disease in 6 patients and persistence in 2. Moreover, r egenerative nodular hyperplasia was noted in 1 case, perisinusoidal fi brosis in 1 case, and cirrhosis in 6 cases. Three patients of group 1 and 11 patients of group 2 returned to dialysis a mean of 21 and 39 mo nths after diagnosis, respectively. Eight patients died and death was clearly associated with major peliosis in 2 cases. In kidney transplan t recipients, vascular hepatic disease may be associated with high mor tality, especially in major forms. Our findings indicate that peliosis hepatis may lead to severe fibrosing liver lesions. The course of vas cular hepatic disease is not clearly modified by AZA withdrawal.