Repeated detection of gas in the portal vein after liver transplantation: A sign of EBV‐associated post‐transplant lymphoproliferation?

Abstract

A 1-yr-old child presented with intractable right sided pleural effusion and progressive clinical deterioration 3 weeks after liver transplantation for Alagille Syndrome. He had been treated successfully for severe acute rejection before. Ultrasound and Doppler mode studies repeatedly demonstrated air in the portal vein. Intra-abdominal and intra-thoracic lymphoproliferation was detected, and EBV virus load and serology were suggestive of primary EBV infection. Liver biopsy revealed blast-like infiltrates of B-cells, considered diagnostic for post-transplant lymphoproliferative disease. The disease resolved upon reduction of immunosuppression. We suggest that the detection of portal vein gas in pediatric liver transplant recipients beyond the early post-operative period may be a sign of intra-abdominal post-transplant lymphoproliferative disease.

Pnematosis Intestinalis and Portal Venous Gas in Pediatric Liver Transplant Recipient

“…Post–liver transplant pneumatosis intestinalis in the pediatric population is rare, associated with severe symptoms, and directly attributable to steroids in the immune suppression regime or underlying Epstein–Barr virus infection (1–3). Our patient remained asymptomatic, was on steroid‐free immune suppression, with no rejection, and had a benign course, thereby having a unique presentation and progress.…”

Necrotizing enterocolitis in the setting of milk allergy after pediatric living donor liver transplantation

“…PVG following LT has been reported as a common (frequency of 18%) and clinically insignificant sign in the early postoperative period . There have been reports that PVG can be caused by several clinically significant diseases, such as enteritis, graft failure, ileus, and post‐transplantation lymphoproliferative disorder . At our institute, we experienced 12 PVG cases of 414 pediatric LT cases (2.9%).…”

“…17,18 There have been reports that PVG can be caused by several clinically significant diseases, such as enteritis, graft failure, ileus, and post-transplantation lymphoproliferative disorder. 17,19,20 At our institute, we experienced 12 PVG cases of 414 pediatric LT cases (2.9%). One was associated with intestinal anastomotic leakage and underwent surgical intervention.…”

Detection of Portal Venous Gas by Ultrasonography after Liver Transplantation: A Possible Early Sign of Bacterial Translocation

“…PVG, which indicates the translocation of air into the portal vein system, requires the loss of bowel wall mucosa Copyright © 2012 SciRes. OJOTS integrity [4]. Sebastià, et al described the causes of the loss of bowel wall mucosa integrity and divided them into four groups: 1) Intestinal wall alterations (inflammatory bowel disease, mesenteric ischemia); 2) Bowel distention (gastric and bowel dilatation due to spontaneous, traumatic, and iatrogenic causes); 3) Intra-abdominal sepsis (diverticulitis, abdominal wall gangrene, pylephlebitis); 4) Unknown causes [2].…”

“…On the other hand, PVG has been detected in cases following medical procedures inducing iatrogenic gastric and bowel dilatation, such as colonoscopy, and their prognosis is favorable and a laparotomy is not required [2]. In the setting of organ transplantation, especially the liver, PVG has been reported in association with venovenous bypass, the administration of OKT3 [3], and Epstein-Barr virus (EBV)-associated post-transplant lymphoproliferative disease (PTLD) [4] other than those causes described above. Chezmar, et al previously described that PVG is a common finding in the first 2 weeks after hepatic transplantation and may not have grave prognostic significance [5].…”