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Massive haemoptysis after living donor liver transplantation

¹ Department of General Surgery and Abdominal Organ Transplantation Niguarda Hospital, 20162 Milan, Italy
² Department of Human Anatomy, Faculty of Medicine, 20162 Milan, Italy
³ Department of Pathology Niguarda Hospital, 20162 Milan, Italy

Correspondence to:
Dr M Vertemati
Via Mangiagalli 31 31, Milano 20130, Italy; maurizio.vertemati{at}unimi.it
ABSTRACT
A 27 year old man with hereditary haemorrhagic telangiectasia who developed progressive liver dysfunction underwent living related right lobe transplantation. Pulmonary arteriography did not reveal arteriovenous malformation or abnormal intrapulmonary venous channels. The postoperative course was characterised by persistent hypoxaemia and respiratory failure developed. On day 6, a massive haemoptysis developed and the patient died shortly thereafter. The native liver showed a nodular pseudocirrhotic transformation, with highly dilated and irregularly interconnected vein-like or arterial-like structures in the fibrous septa. Pathological examination of both lungs showed irregular thickening of the wall of the arteries, secondary to eccentric and/or concentric myointimal hyperplasia. This case suggests that massive haemoptysis can develop even when arteriovenous malformations are undetectable by pulmonary arteriography, and it questions the role and the appropriateness of living donor liver transplantation in high risk patients.

Keywords: hereditary haemorrhagic telangiectasia; liver transplantation; haemoptysis