Anti-CD25 and tacrolimus therapy may not prevent early primary biliary cirrhosis recurrence after liver transplantation: two case reports.
Primary biliary cirrhosis (PBC) is an immune-mediated disorder of unknown cause characterized by progressive destruction of intrahepatic bile ducts and the presence of antimitochondrial antibodies. There is no known cure for PBC, and treatment generally includes various combinations of ursodeoxycholic acid and immunosuppressive agents. However, in most patients with end-stage PBC, liver transplantation offers a good quality of life. Recurrent PBC after transplantation is controversial, because most patients with suspected recurrent disease are asymptomatic. Antimitochondrial antibodies frequently persist and do not correlate with disease recurrence. However, most studies support disease recurrence within the graft. The effects of immunosuppression may modify or delay disease expression within the graft. If PBC recurs, intermediate-term patient and graft survivals are excellent, but the long-term outcome remains unknown. Many immunosuppressive agents have been studied with regard to their anti-recurrence properties; however, no standard therapy has been established for this group of patients. In this study we present two patients transplanted for PBC who displayed early recurrence of disease confirmed by liver biopsy and elevated serum AMA. Both individuals received the same immunosuppressive regimen. The data suggest that two doses of daclizumab and tacrolimus monotherapy in the early posttransplant period is insufficient to prevent recurrence of PBC. Addition of glucocorticoids may have beneficial effects in these patients.
Foroncewicz
B
B
Department of Immunology, Transplant Medicine, and Internal Diseases, Medical University of Warsaw, Poland.
Mucha
K
K
Paczek
L
L
Oldakowska-Jedynak
U
U
Górnicka
B
B
Zieniewicz
K
K
Nyckowski
P
P
Krawczyk
M
M
D000328:Adult; D015703:Antigens, CD / Q000276:immunology; D005260:Female; D006801:Humans; D008105:Liver Cirrhosis, Biliary / Q000601:surgery*; D016031:Liver Transplantation / Q000276:immunology*; D008775:Methylprednisolone / Q000627:therapeutic use; D008875:Middle Aged; D015375:Receptors, Interleukin-2 / Q000276:immunology*; D012008:Recurrence; D016559:Tacrolimus / Q000627:therapeutic use*; D016896:Treatment Outcome
D015703:Antigens, CD; D015375:Receptors, Interleukin-2; D016559:Tacrolimus; D008775:Methylprednisolone