Tohoku J. Exp. Med., 2007, 211(2)

Case Report

Steroid-Resistant Late Acute Rejection after a Living Donor Liver Transplantation: Case Report and Review of the Literature

CHIKASHI NAKANISHI,¹ NAOKI KAWAGISHI,¹ SATOSHI SEKIGUCHI,¹ YORIHIRO AKAMATSU,¹ KAZUSHIGE SATO,¹ SHIGEHITO MIYAGI,¹ IKUO TAKEDA,¹ KEISUKE HUKUSHIMA,¹ TAKASHI AISO,¹ AKEHUMI SATO,¹ KEISEI FUJIMORI¹ and SUSUMU SATOMI¹

¹Division of Advanced Surgical Science and Technology, Tohoku University Graduate School of Medicine, Sendai, Japan

The majority of acute cellular rejection occurs in the first few months after liver transplantation. It has been, however, reported that some recipients experience late acute rejection, which occurs more than 3 months after transplantation. We herein report a case of late acute rejection that occurred nearly 10 years after liver transplantation. The patient is a 27-year-old male who underwent a living donor liver transplantation when he was 17 years old. At 9 years 6 months after transplantation, the patient presented with the elevated serum levels of liver enzymes and total bilirubin. A liver biopsy showed acute cellular rejection. Steroid bolus therapy was not effective, but we successfully used deoxyspergualin as a rescue therapy. Late acute cellular rejection that occurs nearly 10 years after transplantation has so far been rarely reported. It is generally believed that late acute rejection may be more resistant to treatment and be associated with a higher rate of graft loss, as well being associated with the development of chronic ductopenic rejection. In this report, we have shown that deoxyspergualin is safe and effective for treatment of steroid-resistant late acute rejection, preventing from graft loss of chronic rejection.

keywords —— liver transplantation; deoxyspergualin; late acute rejection; steroid-resistant

© 2007 Tohoku University Medical Press

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Tohoku J. Exp. Med., 2007, 211, 195-200

Correspondence: Chikashi Nakanishi, M.D., Division of Advanced Surgical Science and Technology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan.

e-mail: chikashi-n@world.ocn.ne.jp