Steroid-resistant late acute rejection after a living donor liver transplantation: case report and review of the literature.
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.
Nakanishi
Chikashi
C
Division of Advanced Surgical Science and Technology, Tohoku University Graduate School of Medicine, Sendai, Japan. chikashi-n@world.ocn.ne.jp
Kawagishi
Naoki
N
Sekiguchi
Satoshi
S
Akamatsu
Yorihiro
Y
Sato
Kazushige
K
Miyagi
Shigehito
S
Takeda
Ikuo
I
Hukushima
Keisuke
K
Aiso
Takashi
T
Sato
Akehumi
A
Fujimori
Keisei
K
Satomi
Susumu
S
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
D004798:Enzymes; D006146:Guanidines; D007166:Immunosuppressive Agents; D001663:Bilirubin; C037258:gusperimus; D008775:Methylprednisolone