Liver transplantation is the definitive treatment for end stage liver disease. Although effective immunosupressants are available, steroid resistance acute rejection (SRAR) can be encountered. In this study we evaluate diagnosis and treatment of SRAR at our center. Since September 2001, 238 liver transplants were performed for 234 patients. Seventy-nine (33.7%) patients developed 98 acute rejection episodes after liver transplant. Eleven (11.2%) of these 98 acute rejection episodes were SRAR, which were analyzed retrospectively. All patients received tacrolimus based immunosuppressive therapy. Liver biopsy was performed for confirmation of acute rejection after vascular or biliary complications were excluded. High dose methylprednisolone was administered for acute rejections. Acute rejection was defined as SRAR if there was no response to steroids. After confirming SRAR by second biopsy; the patients received Antithymocyte globulin (ATG) for10- 14 days with ganciclovir prophylaxis. There were 11 patients (7 male, 4 female; 8 10.7). The mean follow up period of SRARpediatric, 3 adult; mean age14.6 19.1 months (range 5-53 years).The mean time frompatients were 19.4 66.9 days (range 20-181 days). All patientstransplantation to SRAR was 77.3 responded the steroid therapy, but 2 patients required retransplant 7 and 8 months after SRAR therapy due to chronic rejection. These 2 patients died 12 and 32 days after their Retransplant due to sepsis and sudden cardiac arrest. Mean total bilirubin, Aspartate aminotransferase and Alanine aminotransferase levels decreased from 235.2IU/L to 2.4 132.1 IU/L, and 266.79.5 mg/dl, 171.6 12.6 to 28.8 IU/L 30.5 IU/L, and 56.3 2.3 mg/dl, 45.7 respectively. Minor side effects were observed in 6 patients. We did not encounter serious infections and pulmonary edema. In conclusion, according to our experience ATG can be considered as a good therapeutic option in SRAR with acceptable side effects.
Volume : 6
Issue : 4
Pages : 6
Department of General Surgery and Transplantation, Baskent University Faculty of Medicine, Ankara, Turkey