Late acute cellular rejection after switch to everolimus monotherapy at 11 months following liver transplantation

Chantelli Iamblaudiot Razafindrazoto,Frédéric Charlotte,Christiane Stern,Noémie Trystram,Pascal Lebray,Gustavo Miranda Martins

doi:10.1186/s43066-022-00170-7

Abstract

BackgroundAcute cellular rejection beyond the 6th month posttransplant is an uncommon complication after liver transplantation. The inadequate immunosuppression (IS) remains the main risk factor. We report a case of acute cellular rejection after a switch to everolimus monotherapy at 11 months following liver transplantation.Case presentationThis was a 69-year-old man who underwent liver transplantation after hepatocellular carcinoma. The initial immunosuppression was a combination of three immunosuppressive drugs (corticosteroids + tacrolimus + mycophenolate mofetil). The corticosteroid therapy was stopped at the 4th month posttransplant. Serious side effects of the immunosuppressive drugs (agranulocytosis and renal dysfunction), which occurred 4 months after transplantation, required a reduction and then a discontinuation of tacrolimus and mycophenolate mofetil. Everolimus was introduced as a replacement. The patient was consulted at 11 months after liver transplantation, 1 month after stopping the two immunosuppressive drugs, for liver function test abnormalities such as cytolysis and anicteric cholestasis. A moderate late acute cellular rejection was confirmed by a liver biopsy. A satisfactory biological evolution was observed following corticosteroid boluses and optimization of basic immunosuppressive drugs.ConclusionLate acute cellular rejection remains an uncommon complication, observed mostly in the first year after liver transplantation. The main risk factor is usually the decrease of immunosuppression.

Highlights

ConclusionLate acute cellular rejection remains an uncommon complication, observed mostly in the first year after liver transplantation
Acute cellular rejection beyond the 6th month posttransplant is an uncommon complication after liver transplantation
Standard management of acute rejection involves optimization of basic IS such as tacrolimus or cyclosporine associated in case of severe rejection with corticosteroid boluses [2–8]

Summary

Conclusion

LAR remains an uncommon complication, observed mostly in the first year after liver transplantation. LAR is often due to poor patient compliance with IS therapy or unfavorable drug interactions. Methodology: CIR, NT, GMM, CS, FC, and PL. Review, and editing: CIR, NT, GMM, CS, FC, and PL. Data supporting the findings of this study are available from the corresponding author upon reasonable request. A signed consent form authorizing the publication is available and included in the patient’s chart. Author details 1 Department of Gastroenterology, University Hospital Joseph Raseta Befelatanana, 101 Antananarivo, Madagascar. Department of Hepato‐Gastroenterology and Liver Transplantation, University Hospital Pitié Salpêtrière, APHP, Paris, France. Department of Hepato‐Gastroenterology and Liver Transplantation, Hospital Felicio Rocho, Belo Horizonte, Brazil. Department of Pathology, University Hospital Pitié Salpêtrière, APHP, Paris, France

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