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Gazzetta Medica Italiana - Archivio per le Scienze Mediche 2021 April;180(4):136-43

DOI: 10.23736/S0393-3660.19.04240-2

Copyright © 2019 EDIZIONI MINERVA MEDICA

lingua: Inglese

Acute rejection on immune-mediated chronic rejection after liver transplantation

Daria D’AMBROSIO 1 , Daniele TAVANO 1, Barbara LATTANZI 1, Marialuisa FRAMARINO DEI MALATESTA 2, Jean DE VILLE DE GOYET 3, Alessandro CORSI 4, 5, Anna Paola MITTERHOFER 6, Stefano GINANNI CORRADINI 1, Gianluca MENNINI 7, Massimo ROSSI 7, Manuela MERLI 1

1 Unit of Gastroenterology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy; 2 Department of Gynecological, Obstetrical and Urological Sciences, Sapienza University, Rome, Italy; 3 Unit of Pediatric Transplantation, ISMETT, Tor Vergata University, Rome, Italy; 4 Department of Molecular Medicine, Sapienza University, Rome, Italy; 5 Department of Anatomical, Histological, Forensic Medicine and Orthopedics Sciences, Sapienza University, Rome, Italy; 6 Unit of Nephrology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy; 7 Unit of Organ Transplant, Department of General Surgery, Sapienza University, Rome, Italy



Rejection is frequent after liver transplantation (LT). Pathogenesis of acute cellular rejection (ACR) is attributable to recipient T cells; chronic rejection (CR) has a multifactorial pathogenesis. There is a striking increase in LT among women of reproductive age. Thus, it is very important to understand how pregnancy can influence immune system and graft function. An 8-year-old female was liver transplanted in 1990 due to congenital atresia of biliary tract. Patient started immunosuppressive therapy with cyclosporine and corticosteroids. A few weeks after transplantation, she had an acute rejection, treated with fourfold therapy. At 18 years old, a hepatic biopsy showed an immune-mediated chronic hepatitis. Immunosuppressive therapy was increased with azathioprine. In 2014 she had a baby and in 2015 she suspended immunosuppressive therapies. After thirty days, she attended Hospital for jaundice. Histologic examination revealed both chronic hepatitis in cirrhotic evolution and acute rejection. Patient was treated with steroids at high doses. Cyclosporine was replaced with tacrolimus and everolimus, azathioprine was stopped. Due to the clinical conditions, evaluation for a re-LT was started. In the following years, a progressive improvement in patient’s general conditions and liver function was observed and, therefore, re-LT was not necessary. Patient developed a sub-clinical CR and then ACR following suspension of immunosuppressive drugs. Probably, pregnancy played a contribution in the development of liver damage mediated by the immune system. Furthermore, patient completed pregnancy with compensated cirrhosis. Anti-rejection therapy needs to be modulated constantly, obtaining a good clinical response.


KEY WORDS: Liver; Transplants; Therapy; Pregnancy

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