Liver transplantation due to Imatinib induced severe acute liver failure

Abstract

MMA, female, 40 years old, with chronic myeloid leukemia (CML), using Imanitibe 400 mg / day since diagnosed on 06/13/2016; she was hospitalized for investigation on 21/01/2018, with history of jaundice, nausea and vomiting in large amounts one week from the date of hospitalization. After 6 days, patient was diagnosed with severe acute liver failure, 4+/4+ icteric and 5.41 g/dL bilirubin, 2.8, INR 4.1 albumin, moderate ascites, 0.7mg/dL serum level creatine. Transplantation was performed 13 days after hospitalization with the liver of a deceased donor who had brain death. Procedure was conducted without intercurrences. Imatinib is a selective BCR-ABL tyrosine kinase inhibito, an enzyme with activity in Chronic Myeloid Leukemia (CML) and gastrointestinal stromal tumors. The drug is metabolized in the liver by the CYP3A4 enzyme system, and generates many active metabolites. We report a case of a 40-year-old woman on imatinib for 1 year and 7 months until reckognizing her hepatoxicity. The literature recommends that liver function tests are performed prior to the beginning of the treatment, and these parameters be monthly monitored or following clinical recommendations. In addition, it is possible to note that there is a good recovery of the hepatotoxicity in some patients by only terminating the drug if liver changes are punctually diagnosed. The most efficient after transplantation CML management has not yet been set. In the reported case, the use of PRISMA before, during and after transplantation may have been responsible for the good prognosis.