 |
 |
Dear colleagues We have a young woman who underwent liver transplantation for paracetamol induced acute liver failure two months ago. The donor organ came from a patient who had died after using ecstasy. The liver looked normal at surgery, donor LFTs were normal but no biopsy was done. We are not aware of any problems in the donor's past medical history. The recipient is doing well but has persistent cholestasis, with bilirubin 450, AST 400, alk phos 1700 GGT 1300. Liver biopsy shows no evidence of rejection but the liver shows extensive fatty infiltration, with lipid primarily in macrophages. The histological appearances are reminiscent of Niemann-Pick. She has a serum cholesterol concentration of 24 mmol/L with triglycerides 5. Immunosuppression is with tacrolimus. In our experience, such severe hypercholesterolaemia is unusual in cholestasis but it is the combination of the hypercholesterolaemia and the biopsy appearances that is the puzzle. Suggestions would be welcome. William Marshall %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%