Usage of deoxyspergualin on steroid-resistant acute rejection in living donor liver transplantation.
Deoxyspergualin (DSG) is an immunosuppressive agent used to treat steroid-resistant acute rejection after kidney transplantation. But in the case of acute rejection after liver transplantation, DSG was reported effective in just a few cases. From July 1991 to November 2005, 96 patients underwent living donor liver transplantation (LDLTx) in our institution. Of them, 9 patients, including 4 ABO incompatible recipients, are presented. Rejection symptoms that did not respond to steroid pulse therapy (methylprednisolone, 10-20 mg/kg/day for 3 days) and were treated with DSG (3 or 5 mg/kg/day) for 4 to 14 days together with a maintenance dose of the steroid. Among them, five responded to treatment with DSG, two did not respond and the other two patients were not evaluated. Six of the nine patients are symptom free at present. Complications such as leukopenia and thrombocytopenia were successfully treated with granulocyte-colony stimulating factor or by platelet transfusion. No recipient died as a direct consequence of the complications induced by DSG. DSG proved effective and safe for some of the LDLTx recipients with steroid-resistant acute rejection but it was not effective for the treatment of accelerated humoral rejection in ABO incompatible recipients.
Division of Advanced Surgical Science and Technology, Graduate School of Medicine, Tohoku University, Sendai, Japan. kawan@mail.tains.tohoku.ac.jp
Naoki
N
Kawagishi
Kazushige
K
Satoh
Yoshitaka
Y
Enomoto
Yorihiro
Y
Akamatsu
Satoshi
S
Sekiguchi
Susumu
S
Satomi
D000017:ABO Blood-Group System / Q000276:immunology; D000208:Acute Disease; D001781:Blood Component Removal; D001787:Blood Group Incompatibility; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000276:immunology / Q000628:therapy*; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use; D006146:Guanidines / Q000627:therapeutic use*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007223:Infant; D007970:Leukopenia / Q000150:complications / Q000188:drug therapy; D016031:Liver Transplantation / Q000276:immunology*; D019520:Living Donors; D008297:Male; D017713:Platelet Transfusion; D012189:Retrospective Studies; D013921:Thrombocytopenia / Q000150:complications / Q000188:drug therapy; D013997:Time Factors; D016896:Treatment Outcome
D000017:ABO Blood-Group System; D006146:Guanidines; D007166:Immunosuppressive Agents; D016179:Granulocyte Colony-Stimulating Factor; C037258:gusperimus