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The optimal immunosuppressive protocol for the portal vein infusion of PGE 1 and methylprednisolone in pediatric liver transplantation for fulminant hepatic failure of unknown etiology
Author(s) -
Yamada Yohei,
Hoshino Ken,
Irie Rie,
Tomita Hirofumi,
Kato Mototoshi,
Shimojima Naoki,
Fujino Akihiro,
Hibi Taizo,
Shinoda Masahiro,
Obara Hideaki,
Itano Osamu,
Kawachi Shigeyuki,
Tanabe Minoru,
Sakamoto Michiie,
Kitagawa Yuko,
Kuroda Tatsuo
Publication year - 2016
Publication title -
pediatric transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.457
H-Index - 69
eISSN - 1399-3046
pISSN - 1397-3142
DOI - 10.1111/petr.12711
Subject(s) - medicine , etiology , fulminant hepatic failure , calcineurin , liver transplantation , gastroenterology , fulminant , transplantation , incidence (geometry) , methylprednisolone , surgery , physics , optics
The outcome of LTx in pediatric patients with FHF of unknown etiology remains inferior to that of LTx in pediatric patients with cholestatic diseases. A higher incidence of steroid‐resistant severe rejection has been increasingly recognized among the responsible factors. We assessed the efficacy of the administration of steroids and PGE1 via PVI in the management of LTx for FHF in pediatric patients. In our early cohort (1995–2007), seven patients who underwent LTx for FHF of unknown etiology were treated with conventional immunosuppressive therapy (calcineurin inhibitor and a steroid). Seven of eight grafts (one patient underwent re‐LTx) sustained CV and/or CPV associated with ACR, and four patients died of a graft failure or infectious complications that were associated with the treatment for rejection. Of note, the pathological incidence of CV/CPV was significantly higher in recipients with FHF of unknown etiology than in recipients with biliary cholestatic disease during the same study period (87.5% vs. 13.7%, p < 0.00001). From 2008, three patients underwent LTx for cryptogenic FHF with PVI and conventional IS. PVI was well tolerated, and no relevant severe complications were observed. More strikingly, the patients who received PVI overcame biopsy‐proven immunological events and are all currently doing well with excellent graft function after more than five yr. We conclude that PVI is technically safe and effective for preventing severe rejection in pediatric patients who undergo LTx for FHF of unknown etiology and that it does not increase the risk of fatal infectious complications.