Dear Colleagues:

I need your help...

Female patient 32 years old, received her allograft from her brother March/2003, maintained on triple immunosuppression (Steroid / Aza/CsA) with smooth post-operative course. Five months ago she developed hyperbilirubinemia (Bil 5 mg/dl- Indirect 1.9- , ALT 77- AST 44- HCV +ve - CMV equifocal) - US hepatosplenomegaly with dilated portal vein 1.3 cm) she was shifted to FK 506, MMF.

A month ago she was admitted with rising of Bilirubin to 14.7gm/dl- direct 10.4 -Indirect 4.3- ALT 59-AST 91, ALK PHOS 141, HCV PCR+ve (Titre 13000 copies/ml), CMV IgM +ve.  We gave her Gancyclovir for 10 days with initial partial response.

Liver biopsy- Images below- Chronic cholestasi with veno-occlusive disease, mostly due to drug toxicity

We stopped all imuunosuppression- apart from Steroid- but her condition is still static.

Any further suggestions?

Regards.

Dr. Alaa Sabry
Lecturer of Nephrology, Mansoura Urology and Nephrology Center
Masoura University, Egypt
Research Fellow, Northen General Hospital, Herries Road S57AU
Sheffield, UNITED KINGDOM - Phone (hospital) 04401142266822 -(mobile): 044(0)7788526177