Management of Acute Rejection in Paediatric Liver Transplantation.

Management of Acute Rejection in Paediatric Liver Transplantation. Paediatr Drugs. 2013 Aug 8; Authors: Thangarajah D, O'Meara M, Dhawan A Abstract The success of paediatric liver transplantation is attributed to improved surgical techniques and the advent of calcineurin inhibitor-based immunosuppression. Acute rejection (AR) rarely results in graft loss with calcineurin inhibitor immunosuppressive regimens, and the advent of newer agents like interleukin (IL)-2 receptor antibodies. The latter have the benefit of reducing the incidence of AR further and may be of use in patients who are susceptible to recurrent AR, were retransplanted for graft rejection or are in a steroid-sparing regimen. A total of 60 % of all paediatric liver transplants result in AR; however, there is a 75 % response rate to initial steroid therapy. Steroid therapy remains the mainstay of initial AR management, coupled with an increase in baseline immunosuppression. Steroid-resistant rejection (SRR), previously an immediate indication for potent anti-lymphocyte preparations, is now effectively treated with chimeric or humanised IL-2 receptor monoclonal antibodies. Recurrent AR can be treated by adding adjuvant immunosuppressive agents such as mycophenolate mofetil (MMF) or sirolimus. Studies have also demonstrated the efficacy of MMF as rescue therapy for SRR. Anti-lymphocyte preparations such as anti-thymocyte globulin (ATG) and OKT3 are rarely used in SRR but may be of use as...
Source: Paediatric Drugs - Category: Pediatrics Authors: Tags: Paediatr Drugs Source Type: research

Related Links:

Hepatic IgA nephropathy is a complication of chronic liver disease. IgA nephropathy after liver transplantation is rare, especially in children, and carries a significant risk factor for chronic renal failure and mortality. In cases without viral hepatitis, steroid therapy may be useful for IgA nephropathy associated with liver dysfunction. AbstractHepatic IgA nephropathy is a complication of chronic liver disease. IgA nephropathy after liver transplantation is rare, especially in children, and carries a significant risk factor for chronic renal failure and mortality. In cases without viral hepatitis, steroid therapy may b...
Source: Clinical Case Reports - Category: General Medicine Authors: Tags: CASE REPORT Source Type: research
AbstractBlot and colleagues have proposed putative invasive pulmonary aspergillosis (PIPA) definitions for troublesome diagnosis in suspected patients outside the classical criteria of immunosuppression. We retrospectively included in the study all admitted patients with an  Aspergillus spp. positive culture within lower airway samples. Overall, Aspergillus spp. positivity in respiratory samples was 0.97 every 1000 hospital admissions (HA): 4.94 and 0.28/1000/HA, respectively, in intensive care units (ICUs) and medical wards (MW). 66.6% fulfilled PIPA criteria, and 33.4% were def ined as colonized. 69.2% of PIPA ...
Source: Internal and Emergency Medicine - Category: Emergency Medicine Source Type: research
Biliary atresia (BA) is a fibro-obliterative condition of the biliary tree, presenting in infancy. The bilioenteric conduit formed at Kasai portoenterostomy (KPE), achieves restoration of bile flow in approximately 60% of infants. Even if the operation is successful, cirrhosis and its associated complications are, however, common. BA remains the leading cause for liver transplantation (LT) in children. Antibiotic, choleretic, and steroid therapy post-KPE have not convincingly reduced LT rates. Advances in molecular technology have enabled characterisation of the encoded genes of the gut microbiota (gut microbiome). The gut...
Source: Journal of Pediatric Gastroenterology and Nutrition - Category: Gastroenterology Tags: Review Article Source Type: research
Authors: Caputo F, Testino G Abstract Worldwide, cirrhosis due to alcohol-related liver disease (ALD) is responsible for 0.9% of global deaths and 47.9% of cirrhosis-related deaths. End-stage ALD (ESALD) is the final condition of alcohol-related cirrhosis, and severe acute alcohol-related hepatitis (SAAH) is a distinct clinical syndrome associated with the consumption of large amounts of alcohol. In some cases, ESALD, and SAAH may need liver transplantation (LT). The severity of ESALD can improve after a few months (three months) of abstinence from alcohol, avoiding or delaying the need for LT. Conversely, patients...
Source: Minerva Chirurgica - Category: Surgery Tags: Minerva Chir Source Type: research
Authors: Burra P, Bizzaro D, Forza G, Feltrin A, Volpe B, Ronzan A, Feltrin G, Carretta G, D'Amico F, Cillo U, Germani G Abstract Alcohol-related liver disease is one of the most prevalent liver disease worldwide and is the second most common indication for liver transplantation. The majority of transplant programs require 6 months of abstinence prior to transplantation; commonly referred to as the "six-month rule". According to this rule, the patients admitted for severe acute alcoholic hepatitis are not eligible for liver transplantation in most transplant centers. However, there is increasing evidence ...
Source: Minerva Gastroenterologica e Dietologica - Category: Gastroenterology Tags: Minerva Gastroenterol Dietol Source Type: research
Authors: Sarin SK, Sharma S Abstract Severe alcoholic hepatitis (SAH) remains a disease with high mortality. Steroid is the main stay and has been shown to give modest 28-day survival benefit in carefully selected patients, but no 90-day survival benefit. Since non-responders have high incidence of infections and increased mortality, it would be worthwhile to identify them before starting steroid therapy. A high and rising bilirubin, urinary acetyl carnitine>2,500 ng/mL, high asiloglycoprotein positive microparticles, and specific features in liver biopsy could predict steroid non-response at baseline. There is ...
Source: Clinical and molecular hepatology - Category: Gastroenterology Tags: Clin Mol Hepatol Source Type: research
Authors: Shasthry SM Abstract The current standard of care for severe alcoholic hepatitis (SAH) has several limitations in that only up to one-third of patients are eligible for steroid therapy. Additionally, steroids have their own issues: a portion of patients do not respond, while there is doubtful long-term benefit in those who do and a large proportion are ineligible to receive steroids entirely and hence have no definitive options for treatment. As such, there is a large gap between the problem and the available solutions. Alcohol causes dysbiosis and also disrupts gut barrier function, consequently promoting...
Source: Clinical and molecular hepatology - Category: Gastroenterology Tags: Clin Mol Hepatol Source Type: research
Acute graft-versus-host disease (aGVHD), a major obstacle to the success of allogeneic hematopoietic stem cell transplantation (HSCT) and affects 40 –60% of patients undergoing HSCT. GVHD is also a major cause of non-relapse mortality after HSCT. [1-3] Although the management of aGVHD has improved in recent years, [4] a therapeutic gap exists in effective management of aGVHD which is refractory to steroid therapy, particularly in subjects with more severe disease, determined by grade C/D, liver and lower gastrointestinal organ involvement and/or multi-organ involvement, or high risk stratification.
Source: Biology of Blood and Marrow Transplantation - Category: Hematology Authors: Source Type: research
Rationale: Primary sclerosing cholangitis (PSC) is recognized as an autoimmune-mediated liver disease characterized by progressive biliary inflammation and fibrosis. Some PSC cases with elevated immunoglobulin G4 (IgG4) levels are likely to be misdiagnosed with immunoglobulin G4-related sclerosing cholangitis (IgG4-SC). Thus, distinguishing these 2 diseases is particularly important. Patient concerns: A 34-year-old male presented with right hypochondrium abdominal intermittent pain and jaundice lasting for 1 month. Here, we present a case of PSC with increased IgG4 levels with improvement of quality of life upon liver...
Source: Medicine - Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research
We report the case of a 53-year-old-man who developed human T-cell leukemia virus type-1-associated myelopathy (HAM) after ABO-incompatible liver transplantation for alcoholic liver cirrhosis. The living donor was seropositive for human T-cell leukemia virus type-1 (HTLV-1) and the recipient was seronegative for HTLV-1 before transplantation. After transplantation, the recipient developed steroid-resistant acute cellular rejection, which was successfully treated using anti-thymocyte globulin, and he was eventually discharged. He underwent spinal surgery twice after the transplantation for the treatment of cervical spondylo...
Source: Annals of Hepatology - Category: Gastroenterology Tags: Ann Hepatol Source Type: research
More News: Gastroenterology | Liver | Liver Transplant | Nutrition | Pediatrics | Steroid Therapy | Study | Transplants | Urology & Nephrology