title: Steroid-resistant late acute rejection after a living donor liver transplantation: case report and review of the literature.
abstract: The majority of acute cellular rejection occurs in the first few months after liver transplantation. It has been, however, reported that some recipients experience late acute rejection, which occurs more than 3 months after transplantation. We herein report a case of late acute rejection that occurred nearly 10 years after liver transplantation. The patient is a 27-year-old male who underwent a living donor liver transplantation when he was 17 years old. At 9 years 6 months after transplantation, the patient presented with the elevated serum levels of liver enzymes and total bilirubin. A liver biopsy showed acute cellular rejection. Steroid bolus therapy was not effective, but we successfully used deoxyspergualin as a rescue therapy. Late acute cellular rejection that occurs nearly 10 years after transplantation has so far been rarely reported. It is generally believed that late acute rejection may be more resistant to treatment and be associated with a higher rate of graft loss, as well being associated with the development of chronic ductopenic rejection. In this report, we have shown that deoxyspergualin is safe and effective for treatment of steroid-resistant late acute rejection, preventing from graft loss of chronic rejection.
authors.affiliation: Division of Advanced Surgical Science and Technology, Tohoku University Graduate School of Medicine, Sendai, Japan. chikashi-n@world.ocn.ne.jp
authors.forename: Chikashi
authors.initials: C
authors.lastname: Nakanishi
authors.forename: Naoki
authors.initials: N
authors.lastname: Kawagishi
authors.forename: Satoshi
authors.initials: S
authors.lastname: Sekiguchi
authors.forename: Yorihiro
authors.initials: Y
authors.lastname: Akamatsu
authors.forename: Kazushige
authors.initials: K
authors.lastname: Sato
authors.forename: Shigehito
authors.initials: S
authors.lastname: Miyagi
authors.forename: Ikuo
authors.initials: I
authors.lastname: Takeda
authors.forename: Keisuke
authors.initials: K
authors.lastname: Hukushima
authors.forename: Takashi
authors.initials: T
authors.lastname: Aiso
authors.forename: Akehumi
authors.initials: A
authors.lastname: Sato
authors.forename: Keisei
authors.initials: K
authors.lastname: Fujimori
authors.forename: Susumu
authors.initials: S
authors.lastname: Satomi
mesh_terms: D000328:Adult; D001663:Bilirubin / Q000097:blood; D004798:Enzymes / Q000097:blood; D006084:Graft Rejection / Q000188:drug therapy* / Q000473:pathology*; D006146:Guanidines / Q000627:therapeutic use*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016031:Liver Transplantation / Q000473:pathology*; D019520:Living Donors; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D013997:Time Factors
chemical_list: D004798:Enzymes; D006146:Guanidines; D007166:Immunosuppressive Agents; D001663:Bilirubin; C037258:gusperimus; D008775:Methylprednisolone