Skip to main content
Log in

Liver transplantation for PNH with Budd-Chiari syndrome

A case report

  • Brief Reports
  • Published:
Transplant International

Abstract

A 54-year-old male patient with end-stage liver failure from Budd-Chiari syndrome due to paroxysmal nocturnal hemoglobinuria (PNH) underwent liver transplantation (OLT) in 1989. Retransplantation became necessary 1 year later when thrombotic occlusion of the portal vein and common hepatic artery led to graft loss after withdrawal of anticoagulation therapy because of several gastrointestinal bleeding episodes. The patient is now alive 3 years after the first OLT. To the best of our knowledge and according to the literature, this is, to date, the longest that any PNH patient has survived after liver transplantation. Although the course of this patient was complicated in a way similar to that reported for other cases in the literature, patients with PNH should not, in principle, be excluded from liver transplantation. Lifelong anticoagulation with coumarin and the use of steroids together with cyclosporin reduce the risk of recurrent thrombosis and PNH crises.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

References

  1. Antin JH, Ginsburg D, Smith BR, Nathan DH, Orkin SH, Rappeport JM (1985) Bone marrow transplantation for paroxysmal nocturnal hemoglobinuria: eradication of the PNH clone and documentation of complete lymphohematopoietic engraftment. Blood 66:1247–1250

    Google Scholar 

  2. Bismuth H, Sherlock DJ (1991) Portosystemic shunting versus liver transplantation for the Budd-Chiari syndrome. Ann Surg 214:581–589

    Google Scholar 

  3. Blaas P, Berger B, Weber S, Peter HH, Hänsch GM (1988) Paroxysmal nocturnal hemoglobinuria. Enhanced stimulation of platelest by the terminal components is related to the lack of C8bp in the membrane. J Immunol 140:3045–3051

    Google Scholar 

  4. Blaas P, Weber S, Hänsch GM, Peter HH (1990) Paroxysmale nächtliche Hämoglobinurie. Klin Wochenschr 68:247–255

    Google Scholar 

  5. Bouliere M, Le Treut YP, Castellani P, Arnoux D, Bordigoni L, Maillot A, Antoni M, Botte D, Pol B, Gauthier AP (1990) Acute Budd-Chiari synrome with hepatic failure and obstruction of the inferior vena cava as presenting manifestation of hereditary protein C deficiency. Gut 31:949–952

    Google Scholar 

  6. Campbell DA, Rolles K, Jamieson N, O'Grady J, Wight D, Williams R, Calne Sir Roy (1988) Hepatic transplantation with perioperative and long-term anticoagulation as treatment for Budd-Chiari syndrome. Surg Gynecol Obstet 166:511–518

    Google Scholar 

  7. Das M, Caroll SF (1985) Antithrombin III deficiency: an etiology of Budd-Chiari syndrome. Surgery 97:242–245

    Google Scholar 

  8. Feigin RD, Glickson M, Varstending A, Luria B, Gordon RL, Ring EJ, Tur-Kaspa R (1990) Familial Budd-Chiari syndrome due to membranous obstruction on the right hepatic vein treated with transluminal angioplasty. Eur J Gastroenterol 85:94–97

    Google Scholar 

  9. Halff G, Todo S, Tzakis AG, Gordon TE (1990) Liver transplantation for the Budd-Chiari syndrome. Ann Surg 211: 43–49

    Google Scholar 

  10. Kinoshita T, Medof ME, Silker R, Nussenzweig V (1985) Distribution of decay-accelerating factor in the peripheral blood of normal individuals and patients with paroxysmal nocturnal hemoglobinuria. J Exp Med 162:75

    Google Scholar 

  11. Leibowitz AI, Hartmann RC (1981) The Budd-Chiari syndrome and paroxysmal nocturnal hemoglobinuria. Br J Heamatol 48: 1–6

    Google Scholar 

  12. Logue GL (1977) Effect of heparin on complement activation and lysis of paroxysmal nocturnal hemoglobinuria red cells. Blood 50:239–247

    Google Scholar 

  13. McDermott WV, Ridker PM (1990) The Budd-Chiari syndrome and hepatic veno-occlusive disease. Arch Surg 125:525–527

    Google Scholar 

  14. Nicholson-Weller JP, March S, Rosenfeld I, Austen KF (1983) Affected erythrocytes of patients with paroxysmal nocturanal hemoglobinuria are deficient in the complement regulatory protein decay-accelerating factor. Proc Natl Acad Sci USA 80: 5066–5080

    Google Scholar 

  15. Okada N, Harada R, Okada H (1990) Erythrocytes of patients with paroxysmal nocturnal hemoglobinuria acquire resitance to complement attack by purified 20-kD homologous restriction factor. Clin Exp Immunol 80:109–113

    Google Scholar 

  16. Okuda K, Kanamaru A, Uedo E, Kitani T, Okada N, Okada H, Kakishita E, Nagai K (1990) Expression of decay-accelerating factor on hematopoietic progenitors and their progeny cells grown in cultures with fractioned bone marrow cells from normal individuals and patients with paroxysmal nocturnal hemoglobinuria. Exp Hematol 18:1132–1136

    Google Scholar 

  17. Oldhafer KJ, Ringe B, Wittekind C, Pichlmayr R (1990) Budd-Chiari syndrome: portocaval shunt and subsequent liver transplantation. Surgery 107:471–474

    Google Scholar 

  18. Paglucia A, Mufti GJ, Janossa-Tahernia R, Eridani S, Westwood NB, Thumpston J, Sawyer B, Sturgess R, Williams R (1990) In vitro colony culture and chromosomal studies in hepatic and portal vein thrombosis — possible evidence of an occult myeloproliferative state. Q J Med 76:981–989

    Google Scholar 

  19. Schmid T, Sandbichler P, Pernthaler H, Vogel W, Kunz F, Schmid K, Margreiter R (1989) Multiple venous thrombosis with recurrence to Budd-Chiari syndrome after liver transplantation for paroxysmal nocturnal hemoglobinuria. Clin Transplant 3:194–197

    Google Scholar 

  20. Schubert J, uciechowski P, Delany P, Tischler H-J, Kolanus W, Schmidt RE (1990) The PIG-anchoring defect in NK lymphocytes of PNH patients. Blood 76:1181–1187

    Google Scholar 

  21. Settmann HJ, Dekker A, Van Thiel DH, Boggs DR, Starzl TE (1983) Budd-Chiari syndrome recurring in a transplanted liver. Gastroenterology 84:640–643

    Google Scholar 

  22. Sholar PW, Bell WR (1985) Thrombolytic therapy for inferior vena cava thrombosis in paroxysmal nocturnal hemoglobinuria. Ann Intern Med 103:539–541

    Google Scholar 

  23. Tomiyama J, Ninomiya H, Abe T (1990) Enhanced complement susceptibility and dysfunction of lymphocytes in paroxysmal nocturnal hemoglobinuria (PNH). Br J Haematol 76:540–544

    Google Scholar 

  24. Valla D, Casadevall N, Lacombe C, Varet B, Goldwasser E, Franco D, Maillard JN, Patiente EA, Leporrier M, Rueff B, Muller O, Benhamou JP (1985) Primary myeloproliferative disorder and hepatic vein thrombosis. A prospective study of erythroid colony formation in vitro in 20 patients with Budd-Chiari syndrome. Ann Intern Med 103:329–334

    Google Scholar 

  25. Valla D, Dhumeaux D, Babany G, Hillon P, Rueff B, Rochant H, Benhamou J-P (1987) Hepatic vein thrombosis in paroxysmal nocturnal hemoglobinuria. Gastroenterology 93:569–575

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

About this article

Cite this article

Schattenforh, N., Bechstein, W.O., Blumhardt, G. et al. Liver transplantation for PNH with Budd-Chiari syndrome. Transplant Int 6, 354–358 (1993). https://doi.org/10.1007/BF00335976

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF00335976

Key words

Navigation