Sirolimus for Rescue of Steroid and Anti-Thymocyte Globulin–Resistant Recurrent Acute Rejection After Liver Transplantation: Report of One Case

• Published in: Transplantation proceedings Vol. 41; no. 1; pp. 435 - 436
• Main Authors: Demirağ, A, Kalayci, M, Ekci, B, Gülçelik, T, Gökçe, Ö
• Format: Journal Article Conference Proceeding
• Language: English
• Published: Amsterdam Elsevier Inc 2009; Elsevier
• Subjects: Adult; Antibacterial agents; Antibiotics. Antiinfectious agents. Antiparasitic agents; Antilymphocyte Serum - adverse effects; Biological and medical sciences; Drug Resistance; Endothelium, Vascular - pathology; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Graft Rejection - drug therapy; Hepatitis C - complications; Humans; Immunosuppressive Agents - adverse effects; Immunosuppressive Agents - therapeutic use; Liver Failure - surgery; Liver Failure - virology; Liver Transplantation - immunology; Liver Transplantation - pathology; Liver, biliary tract, pancreas, portal circulation, spleen; Magnetic Resonance Imaging; Male; Medical sciences; Pharmacology. Drug treatments; Portal Vein - pathology; Sirolimus - therapeutic use; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Tissue, organ and graft immunology; Treatment Outcome; Antineoplastic agent; Steroid; Graft(material); Rescue; Relapse; Sirolimus; Liver; Homotransplantation; Macrocycle; Surgery; Graft; Protein synthesis inhibitor; Antithymocyte globulin; Corticosteroid; Digestive system; Acute; Lactone; Recurrent; Macrolide; Case study; Medicine; Rejection; Resistance; Antibiotic; Treatment; Immunosuppressive agent; Antibacterial agent; Liver transplantation
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2008.10.063

Abstract Sirolimus (SRL) not only displays prophylactic activity, it also reverses acute rejection (AR) in humans with ongoing refractory renal allograft rejection and chronic liver allograft rejection. The present case of a human liver allograft recipient documents the utility of SRL therapy for a patient experiencing ongoing resistant recurrent AR just after orthotopic liver transplantation (OLT) and liver dysfunction that had not abated after treatment with corticosteroids and antilymphocyte globulin. SRL was added to the mycophenolate mofetil/steroid regimen to treat the ongoing rejection. The patient was rescued with SRL, not experiencing AR again. To date the patient has exhibited no significant side effects after more than 6 months of SRL therapy and his clinical and general condition have been good; he is completely involved in daily life. SRL is a new and safe immunosuppressive agent for rescue in patients with early OLT and recurrent AR.