Acute liver allograft rejection (AR) episodes refractory to antilymphocyte preparations almost inevitably progress to transplantation loss. Sirolimus (SRL) rescue therapy for refractory rejection in renal transplantation has been reported in literature but information regarding rescue therapy for refractory rejection in liver transplant is scarce. To reverse ongoing rejection processes, we administered SRL after failure of conventional immunosuppressive regimens including full courses of antilymphocyte sera. Compared with the calcineurin inhibitors, SRL has different mechanisms of action and side effects profile. Thus, this drug offers significant potential advantages over other immunosuppressive agents. SRL inhibits the signal of interleukin 2 at a post-receptor level, inhibiting lymphocyte proliferation and fibroblast proliferation. It also has antineoplastic and antifungal effects. We report a 26 years old man who underwent Orthotopic Liver Transplant (OLT) due to hepatits C related liver failure, experiencing a biopsy-proven recurrent acute rejection (AR) following 2 weeks after transplant. The patient initially received two 20-mg doses of basiliximab (days 0 and 4 after OLT) followed by tacrolimus (0.15 mg/kg/day; 10-15 ng/mL target through levels), steroids (methylprednisolone 1 g intraoperatively followed by tapering doses) and mycophenolate mofetil (MMF) 1 g every 12 hours. Steroid resistant acute rejection episodes did not respond to anti-thymocyte globulin treatment. The patient was rescued with SRL, not experiencing AR again. MMF and steroids were continued and tacrolimus treatment was stopped, without experiencing severe complications. SRL is a new and safe immunosuppressive agent to rescue patients with OLT and recurrent AR.
Volume : 6
Issue : 4
Pages : 35
Department of Surgery, Yeditepe University Hospital, Istanbul, Turkey