Of Rejection

Allograft rejection occurs in approximately two thirds of children following liver transplantation. The peak incidence of acute rejection is within the first 2-6 weeks following the transplant. Fever, jaundice and abdominal pain are typical symptoms at presentation. Frequent monitoring of biochemical indicators of cholestasis and hepatocellular injury may allow the clinician to suspect rejection prior to the onset of typical physical signs. Since the laboratory and physical signs are not specific for rejection, the diagnosis of rejection must always be confirmed by histology. Rejection episodes are treated in a step-wise fashion. The first step is an intensified steroid regimen, which includes intravenous boluses of methylprednisolone (10-20 mg/kg/day for 3 days) occasionally, followed by tapering doses of oral steroids. If there is no improvement in the biochemical parameters or the liver histology, the next step in treatment might be an antilymphocyte preparation such as OKT3, or conversion from cyclosporine to tacrolimus. Chronic rejection can occur either following an episode of refractory acute rejection or denovo weeks to months after transplant. Chronic rejection is characterized by a slow progression of the clinical signs of cholestasis without many constitutional symp

0 0

Post a comment