allopurinol and Cholangitis

An unusual type of diffuse biliary tract injury after liver transplantation that is characterized by multiple intrahepatic biliary strictures, ductal dilatations, fluid collections, or intrahepatic abscesses has been identified. Over a 5-year period, a total of 10 patients (2%) developed diffuse intrahepatic biliary injury with established vascular patency and no obvious source for their biliary tract pathology. All patients received livers preserved in University of Wisconsin solution with a mean preservation time of 16 hours. This biliary tract injury was associated with the presence of severe preservation injury and Roux limb biliary reconstruction. Of the 10 patients, 5 were treated nonoperatively with multiple stricture dilations and stent placements, 3 underwent retransplantation, 1 was treated operatively with hepaticojejunostomy, and 1 died of sepsis. This study suggests that this complication appears to be related to preservation injury and that the etiology may be ischemic in origin.

Topics: Adenosine; Adolescent; Adult; Aged; Alanine Transaminase; Allopurinol; Aspartate Aminotransferases; Bile Duct Diseases; Biliary Tract Diseases; Child; Child, Preschool; Cholangitis; Follow-Up Studies; Glutathione; Graft Survival; Hepatic Artery; Humans; Hypertonic Solutions; Infant; Infant, Newborn; Insulin; Jaundice; Liver; Liver Transplantation; Middle Aged; Organ Preservation; Organ Preservation Solutions; Raffinose; Reoperation; Retrospective Studies; Solutions; Thrombosis

Topics: Acute Disease; Allopurinol; Cholangitis; Drug Hypersensitivity; Humans; Male; Middle Aged

A 36-year-old man had pain in both knees and an elevated uric acid concentration; his liver function was normal. Allopurinol therapy was started, 100 mg twice daily. After one month fever, lethargy, and severe polyarthralgia developed. On admission to our hospital liver function was abnormal, and a liver biopsy specimen showed granulomas with cholangitis and pericholangitis. He also had lymphopenia with a reduced number of T cells and granulomas in the bone marrow. One month after discontinuation of allopurinol therapy the patient was clinically well with normal liver function and a normal lymphocyte count. A repeated liver biopsy specimen showed normal liver tissue with no granulomas. The onset of the symptoms and findings shortly after the initiation of allopurinol therapy, and their disappearance after the discontinuation of therapy suggest a drug-induced hypersensitivity.

Topics: Allopurinol; Chemical and Drug Induced Liver Injury; Cholangitis; Granuloma; Humans; Liver Diseases; Male; Middle Aged; Sarcoidosis