Rescue FK506 Therapy for Acute Rejection and Early Chronic Rejection After Liver Transplantation: Report of 14 Cases

Abstract

From January 1990 to May 1996, 148 male and 99 female patients had 265 liver transplantation (LTx) and 18 (6.7%) retransplantations. The mean age was 46.6 years. A cyclosporine-based immunosuppression was used. Ninety-four patients (38%) had 116 episodes of rejection. Thirty-seven of 86 patients treated by steroid bolus were steroid resistant, requiring orthoclone therapy. In eight (3.2%) other patients, orthoclone was used without previous steroid bolus. In 14 cases (6%), refractory rejection required rescue FK506 therapy. There were seven men and seven women with a mean age of 38 years (from 14 to 56). Indications for LTx were alcoholic cirrhosis (N 5 4), post-VHC cirrhosis (N 5 2), post-VHB cirrhosis (N 5 2), fulminant liver failure (N 5 3), giant liver hemangioma (N 5 1), hemochromatosis (N 5 1), and liver metastasis of pancreatic neuroendocrine tumour (N 5 1). Rescue FK506 was done for nine patients after failure of steroid bolus and orthoclone therapy, for three patients after failure of orthoclone therapy without previous steroid bolus, and for two patients after failure of steroid bolus without orthoclone therapy. Only oral formulation of FK506 was used in association with steroids and azathioprine. There were six cases of early chronic rejection (less than 50% of bile duct loss), each had a mean of three rejection episodes, 1.8 steroid bolus therapy, and 1.4 orthoclone therapy. Eight cases of acute rejection (four early rejection , 30 days post-LTx, and four late acute rejection . 1 month post-LTx) each had a mean of two rejection episodes, 1.5 steroid bolus therapy and 1.5 orthoclone therapy.