SUCCESSFUL TREATMENT OF SEVERE AZATHIOPRINE-INDUCED HEPATIC VENOOCCLUSIVE DISEASE IN A KIDNEY-TRANSPLANTED PATIENT WITH TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC SHUNT

Azathioprine-induced veno-occlusive disease of the liver mainly descri bed after kidney transplantation is as rare as severe with a high mort ality due to acute portal hypertension and liver failure. A kidney-tra nsplanted patient with severe azathioprine-induced veno-occlusive dise ase of the liver and worsening despite drug discontinuation was treate d by emergency transjugular intrahepatic portosystemic shunt. Whereas the veno-occlusive disease was controlled, the patient developed sever e intractable portosystemic encephalopathy successfully treated by a s tent reducer maintaining a certain degree of portal diversion. Twelve months after transjugular intrahepatic portosystemic shunt, liver func tion was normalized and the stent was thrombosed with a subnormal live r histology. Thirty-six months after transjugular intrahepatic portosy stemic shunt the patient is alive with normal liver function tests and kidney graft function. Transjugular intrahepatic portosystemic shunt for treatment of severe veno-occlusive disease of the liver is an alte rnative to tide the patient over until recovery of liver function.