Strategies in clinical diagnosis and treatment of steroid-resistant acute rejection after orthotopic liver transplantation
10.3760/cma.j.issn.1007-3418.2016.04.011
- VernacularTitle:原位肝移植术后耐激素性急性排斥反应的临床诊治策略
- Author:
Xinjun LU
1
;
Yinghua CHEN
;
Yi MA
;
Xiaofeng ZHU
;
Xiaoshun HE
Author Information
1. 中山大学附属第一医院器官移植中心
- Keywords:
Liver transplantation;
Diagnosis;
Therapy;
Steroid resistant acute rejection
- From:
Chinese Journal of Hepatology
2016;24(4):297-301
- CountryChina
- Language:Chinese
-
Abstract:
Objective To explore the diagnostic evidence and treatment strategies for steroid-resistant acute rejection (SRAR) after orthotopic liver transplantation.Methods A retrospective analysis was performed among 1038 patients undergoing orthotopic liver transplantation in our hospital from January 2004 to December 2013.A total of 169 acute rejection (AR) episodes occurred in 153 patients.Sixteen of the patients were diagnosed with SRAR because of no response to large-dose steroid pulse therapy.The diagnosis and treatment of the 16 patients were analyzed retrospectively.Comparison of data was made by x2 test or t test,and a P value of＜0.05 was considered to be significant.Results The incidence of AR after liver transplantation was 14.74％ (153/1038) in all the patients.The incidence of SRAR was 9.47％ (16/169) in patients with AR.In the 16 patients with SRAR,3 were treated with anti-CD3 monoclonal antibody (OKT3),9 were treated with monoclonal antibody against IL-2 receptor,and 4 received antithymocyte globulin (ATG) therapy.After treatment,SRAR was reversed in 12 of the 16 patients and caused death of the other 4 patients,yielding a reversal rate of 75％ and a mortality rate of 25％.Conclusion SRAR after liver transplantation has a low incidence rate but poor prognosis.The diagnosis of SRAR is mainly based on the clinical manifestation,laboratory test,liver biopsy,and poor response or rejection to methyl prednisolone pulse therapy.ATG and OKT3 achieve substantial outcomes in most of the patients in the treatment of SRAR.Particularly,compared with OKT3,ATG achieves a higher reversal rate and fewer adverse reactions,which is expected to become the first-line treatment of SRAR.
