What Are Symptoms of a Liver Transplant Rejection?
About 10% of patients can develop chronic rejection, also known as vanishing bile duct sydrome (VBDS), chronic allograft liver rejection. It is characterized by progressive cholestasis, increased bilirubin, elevated alkaline phosphatase, and normal albumin and prothrombin times. Liver transplantation often enlarges and hardens, but portal hypertension is rare. Liver pathological manifestations include destruction of interlobular bile ducts, progressive fibroplasia, disappearance of cell infiltration in the manifold area, fibrosis of vascular intima, and sometimes foam cells. VBDS is almost irreversible. Re-transplantation required.
Liver transplant rejection
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- Chinese name
- Liver transplant rejection
- Foreign name
- vanishing bile duct sydrome
- Also known as
- Vanishing bile duct syndrome
- Short name
- VBDS
- About 10% of patients can develop chronic rejection, also known as vanishing bile duct sydrome (VBDS), chronic allograft liver rejection. It is characterized by progressive cholestasis, increased bilirubin, elevated alkaline phosphatase, and normal albumin and prothrombin times. Liver transplantation often enlarges and hardens, but portal hypertension is rare. Liver pathological manifestations include destruction of interlobular bile ducts, progressive fibroplasia, disappearance of cell infiltration in the manifold area, fibrosis of vascular intima, and sometimes foam cells. VBDS is almost irreversible. Re-transplantation required.
- So far no typical
- The prevention and treatment of liver transplant rejection requires the use of immunosuppressants. Its role is to suppress cell-mediated immune responses. Inhibits cytotoxic T lymphocytes and inhibits cytokine gene activity (IL-1, IL-2, IL-3, IL-4, TNF-a). Immunosuppressants include cyclosporin A, corticosteroids (hydrocortisone, prednisone, prednisone, methylprednisolone). FK506 (tacrolimus), Snapsil (mycophenolate mofetil, MMF) and monoclonal antibody OKT3 (muromonab CD3, ortholone). The plan must be individualized.
- Methylprednisolone 250 ~ 500mg is commonly used in transplantation, and it is given intravenously at one time. After surgery, the dose is gradually reduced and the maintenance amount is 20 ~ 25mg. For acute rejection, 500-1000 mg / d can be injected intravenously. After 3 days of shock treatment, the drug can be gradually reduced and gradually reduced to a maintenance amount after one month.
- Cyclosporin A is often used in combination with adrenal glucocorticoids and / or azathioprine. The intravenous dose of cyclosporin A is 1 to 6 mg / kg / d; the oral dose is 8 to 15 mg / kg / d. Azathioprine is 1 to 3 mg / d. The methylprednisolone is 0.5 to 2.0 mg / kg / d. Anti-lymphocyte antibody serum 5mg / kg / d. When cyclosporine A has a whole blood concentration of 50 to 800 ng / ml or a plasma concentration of 50 to 300 ng / ml, the effect is significant and the adverse reactions are minimal.
- FK506 has been used clinically in recent years. Generally the first dose is 0.15mg / kg, and it has been changed to 0.075mg / kg since then. Intravenous once every 12 hours. After 1 to 2 hours, the medicine will be taken orally after 2 to 3 days. The dose will be 0.3 mg / kg / d, divided into 1 or 2 times. Can be combined with methylprednisolone 10mg / d, intravenous injection or prednisone 20mg / kg / d, intravenous injection. The maintenance dose of FK506 is 5 ~ 200mg / d.