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Presenter: Andrea, Pietrobattista, Birmingham, UK, United Kingdom
Authors: Andrea Pietrobattista1, Sara Gozzini1, Khalid Sharif1, Paolo Muiesan1, Darius Mirza1, Girish Gupte1
Andrea Pietrobattista, Sara Gozzini, Khalid Sharif, Paolo Muiesan, Darius Mirza, Girish Gupte
Liver Unit including small bowel trasplantation, Birmingham Children Hospital, Birmingham, United Kingdom
Introduction and aim: Acute rejection (AR) affects > 60% of ITx between day 5- 60. Limited data exists about late onset AR (>6 months post-ITx). Aim of our study is to evaluate the incidence of late onset of AR in SBT.
Methods: Retrospective review of ITx 1998-2009 with confirmed histopathological diagnosesof late onset AR. 57 patients for a total of 63 SBT were included in the study.
Results: Of the 112 episodes of AR, 59 (52%) presented as late onset. 8 patients (12.6%), experienced the first episodes at least 6 months after the SBT with 2/8 after 24 months ( graft survival 75%).
Table 1:
|
Liver inclusive graft |
Liver not included in graft |
Treatment |
No of patients |
27 |
2 |
|
No of episodes Mild Moderate Severe |
54 34 8 12 |
5 3 1 1 |
Single MP, ↑ IS 3 boluses MP, ↑IS, ± ATG/OKT3 ATG/OKT3, Campath |
Median age to rejection from post-Tx |
1,86 |
1,94 |
|
Chronic rejection |
3 |
1 |
|
Re-transplantation |
2 |
1 |
|
Survival |
22 |
1 |
|
MP= Methylprenisolone 20 mg /kg to max of 400 mg
IS= Immunosuppression
Discussion: No graft has been removed as part of the treatment for late AR despite the higher incidence of a severe grade (20%) compared with the overall grading of late AR. Levels of IS prior to the episode of rejection reviewed were within the target range.
Conclusion: Late AR is not rare in SBT. Aggressive medical treatment of late onset AR is necessary for essential survival of the patient.
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