title: Graft rejection occurring in post-liver transplant patients receiving cytotoxic chemotherapy: a case series.
abstract: Liver transplant recipients are known to be at increased risk for the development of de novo neoplasms or the recurrence of preexisting malignancies, and this is possibly related to the use of immunosuppressive medication. Little is known about the effects of cytotoxic chemotherapy on graft function after transplantation. A retrospective chart and pathology database review was undertaken to identify post-liver transplant patients developing rejection during chemotherapy. All liver biopsies were reviewed by a hepatopathologist. Three patients were identified. All patients were diagnosed with cancer within 7 years of liver transplantation; two-thirds died soon after the diagnosis of malignancy. Rejection occurred soon after chemotherapy was started. All patients were receiving prednisone and tacrolimus (trough levels: 2.1-4.8 ng/mL). One patient developed plasma cell hepatitis (de novo autoimmune hepatitis). There was no histologic evidence of hepatotoxicity due to the chemotherapeutic agents. Cytotoxic chemotherapy should be used in liver transplant recipients with caution, and immunosuppressant doses should be maintained at therapeutic levels, as patients may be at risk for allograft rejection. Treatment of rejection or plasma cell hepatitis in this setting should be undertaken in a timely and aggressive fashion to prevent chronic ductopenic rejection.
authors.affiliation: Division of Liver Diseases, Department of Medicine, Mount Sinai School of Medicine, New York, NY 10029, USA.
authors.forename: Hui-Hui
authors.initials: HH
authors.lastname: Tan
authors.forename: M Isabel
authors.initials: MI
authors.lastname: Fiel
authors.forename: Juan
authors.initials: J
authors.lastname: del Rio Martin
authors.forename: Thomas D
authors.initials: TD
authors.lastname: Schiano
mesh_terms: D000328:Adult; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001706:Biopsy; D015209:Cholangitis, Sclerosing / Q000601:surgery*; D003110:Colonic Neoplasms / Q000188:drug therapy; D003603:Cytotoxins / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008099:Liver / Q000473:pathology; D008105:Liver Cirrhosis, Biliary / Q000601:surgery*; D008113:Liver Neoplasms / Q000188:drug therapy; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011241:Prednisone / Q000627:therapeutic use; D012189:Retrospective Studies; D012307:Risk Factors; D012878:Skin Neoplasms / Q000188:drug therapy; D016559:Tacrolimus / Q000627:therapeutic use
chemical_list: D000970:Antineoplastic Agents; D003603:Cytotoxins; D007166:Immunosuppressive Agents; D011241:Prednisone; D016559:Tacrolimus