title: Refractory acute rejection in a living related liver transplantation.
abstract: Hepatic allograft rejection after liver transplantation remains an important problem. We report a case of corticosteroid and anti-T cell monoclonal antibody-resistant acute cellular rejection in living related liver transplantation. A 57-year-old female received a right liver graft from her daughter for hepatitis C-related liver cirrhosis. Methylprednisolone and tracrolimus were used for immunosuppression. The patient experienced acute rejection 10 days after the operation. Rescue therapy was attempted using high doses of methylprednisolone and then monoclonal antibodies. Deterioration of graft function, however, was not prevented, resulting in graft and patient loss. Graft lost due to refractory acute rejection could also occur in living related liver transplantation, although it should be rare.
authors.affiliation: Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Noritomi
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Sugawara
authors.forename: Junichi
authors.initials: J
authors.lastname: Kaneko
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Matsui
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Makuuchi
mesh_terms: D001707:Biopsy, Needle; D018450:Disease Progression; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004351:Drug Resistance; D004359:Drug Therapy, Combination; D017809:Fatal Outcome; D005260:Female; D006084:Graft Rejection / Q000188:drug therapy* / Q000276:immunology / Q000473:pathology; D019698:Hepatitis C, Chronic / Q000601:surgery*; D006650:Histocompatibility Testing; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008099:Liver / Q000276:immunology / Q000473:pathology; D008103:Liver Cirrhosis / Q000601:surgery*; D016031:Liver Transplantation / Q000276:immunology* / Q000473:pathology; D019520:Living Donors; D008775:Methylprednisolone / Q000008:administration & dosage; D008875:Middle Aged; D016853:Muromonab-CD3 / Q000008:administration & dosage; D011183:Postoperative Complications / Q000188:drug therapy* / Q000276:immunology / Q000473:pathology; D016559:Tacrolimus / Q000008:administration & dosage
chemical_list: D007166:Immunosuppressive Agents; D016853:Muromonab-CD3; D016559:Tacrolimus; D008775:Methylprednisolone