PROTEIN-LOSING ENTEROPATHY SECONDARY TO HEPATIC VENOUS OUTFLOW OBSTRUCTION AFTER LIVER-TRANSPLANTATION

A 42-year-old man with a history of repeated abdominal surgery and 12 mph node tuberculosis underwent orthotopic Liver transplantation for p rimary sclerosing cholangitis, Two years after transplantation, this p atient developed a severe protein-losing enteropathy with no evidence of cardiac disease or lymphoproliferative disorder, Imaging work-up re vealed hemodynamically significant stenosis of the supra-hepatic caval anastomosis, which was treated by percutaneous balloon angioplasty, A ll clinical and biochemical disorders resolved within 1 month after pe rcutaneous dilatation, but relapsed simultaneously with recurrent anas tomotic stenosis 15 months Inter, Repeat caval angioplasty resulted in rapid recovery, which strongly suggests that hepatic venous outflow o bstruction was responsible for the protein-losing enteropathy in this patient.