Successful liver transplantation for acute sickle cell intrahepatic cholestasis: A case report and review of the literature
| Autor: | Vedha Sanghi, Tavankit Singh, Mohammad Zmaili, Mohannad Abou Saleh, Carol Rouphael, Motasem Alkhayyat, Carlos Romero-Marrero, Christina C. Lindenmeyer, William D. Carey, C. Roberto Simons-Linares |
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| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Anemia medicine.medical_treatment Liver transplantation Gastroenterology 03 medical and health sciences 0302 clinical medicine Cholestasis Internal medicine Case report medicine Leukocytosis Acute intrahepatic cholestasis Liver transplant Hepatology Hepatitis C virus business.industry Sickle cell hepatopathy Acute kidney injury Glecaprevir Jaundice Post-operative surveillance medicine.disease Pibrentasvir 030220 oncology & carcinogenesis 030211 gastroenterology & hepatology medicine.symptom business |
| Zdroj: | World Journal of Hepatology |
| ISSN: | 1948-5182 |
| DOI: | 10.4254/wjh.v12.i3.108 |
| Popis: | Background Sickle cell hepatopathy (SCH) is an inclusive term referring to any liver dysfunction among patients with sickle cell disease. Acute sickle cell intrahepatic cholestasis is one of the rarest and most fatal presentations of SCH. We present the 23rd reported case of liver transplantation (LT) for SCH; a rare case of acute sickle cell intrahepatic cholestasis managed with LT from a hepatitis C virus (HCV) nucleic acid amplification test positive donor. Case summary A 29-year-old male with a past medical history of sickle cell disease presented with vaso-occlusive pain crisis. On examination, he had jaundice and a soft, non-tender abdomen. Initially he was alert and fully oriented; within 24 h he developed new-onset confusion. Laboratory evaluation was notable for hyperbilirubinemia, leukocytosis, anemia, thrombocytopenia, acute kidney injury and elevated international normalized ratio (INR). Imaging by ultrasound and computed tomography scan suggested a cirrhotic liver morphology with no evidence of biliary ductal dilatation. The patient was diagnosed with acute sickle cell intrahepatic cholestasis after excluding competing etiologies of acute liver injury. He underwent LT from an HCV nucleic acid amplification test positive donor 9 d after initial presentation. The liver explant was notable for widespread sinusoidal dilatation with innumerable clusters of sickled red blood cells and cholestasis. On postoperative day 3, HCV RNA was detectable in the patient's peripheral blood and anti-HCV therapy with glecaprevir/pibrentasvir was initiated on postoperative day 23. He subsequently achieved sustained virologic response after completing 3 mo of therapy and has been followed clinically for 12 mo post-transplant. Conclusion This case highlights the utility of LT as a viable treatment option for acute sickle cell intrahepatic cholestasis. |
| Databáze: | OpenAIRE |
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