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Anti‐lymphocyte therapy successfully controls late “cholestatic” rejection in pediatric liver transplant recipients
Author(s) -
Kerkar N.,
Morotti R. A.,
Iyer K.,
Ar R.,
Miloh T.,
Sturdevant M.,
Suchy F.,
Florman S.,
Emre S.
Publication year - 2011
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/j.1399-0012.2011.01494.x
Subject(s) - medicine , tacrolimus , immunosuppression , transplantation , liver transplantation , cholestasis , gastroenterology , surgery
Kerkar N, Morotti RA, Iyer K, Arnon R, Miloh T, Sturdevant M, Suchy F, Florman S, Emre S. Anti‐lymphocyte therapy successfully controls late “cholestatic” rejection in pediatric liver transplant recipients.
Clin Transplant 2011: 25: E584–E591. © 2011 John Wiley & Sons A/S. Abstract: Rejection is independently associated with liver graft loss in children. We report the successful rescue of grafts using ATG+/−OKT3 in late rejection associated with cholestasis. Retrospective chart review was performed after IRB approval. Between 2003 and 2010, 14 pediatric liver transplant recipients received anti‐lymphocyte treatment for “cholestatic” rejection. Median age at transplantation was 12.7 yr (range 0.9–23.4), eight were boys, and immunosuppression was tacrolimus based. Median time from transplantation to rejection was five yr (range 1.1–10.5). Median peak total bilirubin was 11.1 mg/dL (range 1.4–18). All showed moderate to severe acute rejection and hepatocellular cholestasis on histology. ATG/OKT3 was started as first‐line therapy in six and in the remaining eight as second‐line therapy after failure of pulse steroids. Thirteen responded with normalization of aminotransferases and bilirubin, median time 16 wk (range 7–112); one non‐adherent recipient has still not achieved normal graft function at last follow‐up. Patient survival is 100%, with no re‐transplantation and no post‐transplant lymphoproliferative disease, median follow‐up 2.9 yr (range 1.1–7.2). Cholestasis associated with acute rejection occurring late after liver transplantation may herald steroid resistance. First‐line therapy with anti‐lymphocyte preparations, prophylactic anti‐microbial therapy, and close monitoring allow excellent rates of patient and graft survival.