title: Rapamycin successfully treats post-transplant autoimmune hepatitis.
abstract: Rapamycin (Rapa), one of the newer immunosuppressants has been found to control and prevent autoimmune features in animal models. This is the first report describing the successful control of post-transplant autoimmune hepatitis (AIH) with Rapa. Post-transplant AIH is diagnosed in the presence of raised transaminases, elevated immunoglobulin G, presence of autoantibodies and histologic changes consistent with AIH on liver biopsy. It may represent a recurrence of the original AIH that led to transplantation or present as a de novo AIH after liver transplant. Post-transplant AIH has conventionally been treated with Prednisolone (Pred) and Azathioprine (AZA). In this report, tailoring of immunosuppression after diagnosis of post-transplant AIH is described with special emphasis on those treated successfully with Rapa. Fifteen of 21 patients responded to treatment with an increase in dose of Pred and addition of AZA or Mycophenolate Mofetil (MMF) to calcineurin inhibitor. Five non-responders and one other patient with post-transplant AIH were treated with addition of Rapa. All six responded to treatment but drug was withdrawn in one patient. Adverse events were minimal. Rapa may prove to be an important addition in the control of autoimmune liver disease.
authors.affiliation: Recanati Miller Transplant Institute, Department of Pediatrics, Division of Pediatric Hepatology, The Mount Sinai School of Medicine, New York, NY, USA.
authors.forename: Nanda
authors.initials: N
authors.lastname: Kerkar
authors.forename: Christina
authors.initials: C
authors.lastname: Dugan
authors.forename: Carolina
authors.initials: C
authors.lastname: Rumbo
authors.forename: Raffaella A
authors.initials: RA
authors.lastname: Morotti
authors.forename: Gabriel
authors.initials: G
authors.lastname: Gondolesi
authors.forename: Benjamin L
authors.initials: BL
authors.lastname: Shneider
authors.forename: Sukru
authors.initials: S
authors.lastname: Emre
mesh_terms: D001323:Autoantibodies / Q000737:chemistry; D001379:Azathioprine / Q000494:pharmacology; D001706:Biopsy; D065095:Calcineurin Inhibitors; D002648:Child; D002675:Child, Preschool; D019693:Hepatitis, Autoimmune / Q000188:drug therapy*; D006801:Humans; D007074:Immunoglobulin G / Q000096:biosynthesis; D007166:Immunosuppressive Agents / Q000494:pharmacology; D007223:Infant; D007231:Infant, Newborn; D008099:Liver / Q000473:pathology; D008107:Liver Diseases / Q000188:drug therapy; D008297:Male; D009173:Mycophenolic Acid / Q000031:analogs & derivatives* / Q000494:pharmacology; D011183:Postoperative Complications; D011239:Prednisolone / Q000494:pharmacology; D020123:Sirolimus / Q000494:pharmacology*; D013997:Time Factors; D000637:Transaminases / Q000096:biosynthesis; D016896:Treatment Outcome
chemical_list: D001323:Autoantibodies; D065095:Calcineurin Inhibitors; D007074:Immunoglobulin G; D007166:Immunosuppressive Agents; D011239:Prednisolone; D000637:Transaminases; D009173:Mycophenolic Acid; D001379:Azathioprine; D020123:Sirolimus