Liver transplantation in patients with diffuse nodular hyperplasia.

Problems associated with portal hypertension, such as ascites, bleeding esophageal varices and sometimes hepatic encephalopathy, frequently complicate an unusual form of a noncirrhotic liver disease, the diffuse nodular hyperplasia (DNH). Since June 1986 until December 1994, 402 liver transplantations (OLT) have been performed in our center. Three cases of liver DNH treated with OLT are here summaryzed. Patient I) A 36-year-old man presented in December 1987. The preoperative clinical and instrumental diagnosis was: patient with cronic hepatopaty probably due to ethilism, B/C Child grade, esophageal varices III/IV grade, splenomegaly. The pt. was transplanted on February 18, 1988 and he feels currently good. The histopathologlc response was: diffuse nodular hyperplasla. Patient 2) A 40- years-old man presented in June 1988. He underwent kidney transplantation due to Aiport syndrome in 1976. The tranplantation provoked a chronic rejection with progressive kidney insufficiency. In this period the pt. developed hepatic DNH with severe portal hypertension, esophageal varices IV/IV grade and hypersplenism with splenomegaly. He received a double hepatorenal transplantation October 21, 1989 with histologic confirmation of hepatic DNH. Since then he has presented valid renal function, complaining episode of obstructive post-transplant uropathy. The hepatic histology has been relatively compromised by an acute B hepatitis chronic C hepatitis. Patient 3) A 37-years-old man presented in January 1994. The physical and instrumental examinations revealed: chronic diffuse hepatopaty, with a previous C hepatitis virus infection, portal hypertension with several episodes of esophageal varices bleeding, portal vein thrombosis. The pt. was transplanted on April 3, 1994 and the histopathologic finding was DNH. He suicided three months after receiving OLT despite of his satisfactory conditions. OLT may be considered an effective therapy for those patients bearing life-threatening or disabling complications of advanced portal hypertension due to diffuse parenchymal non-cirrothic chronic disease.