Basiliximab treatment for steroid‐resistant rejection in pediatric patients following liver transplantation for acute liver failure

Abstract

An IL-2 receptor antagonist, basiliximab, decreases the frequency of ACR in liver transplant (LT) recipients as induction therapy. The aim of this study was to evaluate the effectiveness of basiliximab against SRR as rescue therapy in pediatric LT patients with ALF. Forty pediatric ALF patients underwent LT between November 2005 and July 2013. Among them, seven patients suffering from SRR were enrolled in this study. The median age at LT was 10 months (6-12 months). SRR was defined as the occurrence of refractory rejection after more than two courses of steroid pulse therapy. Basiliximab was administered to all patients. The withdrawal of steroids without deterioration of the liver function was achieved in six patients treated with basiliximab therapy without patient mortality, although one patient developed graft loss and required retransplantation for veno-occlusive disease. The pathological examinations of liver biopsies in the patients suffering from SRR revealed severe centrilobular injuries, particularly fibrosis within one month after LT. We demonstrated the effectiveness and safety of rescue therapy consisting of basiliximab for SRR in pediatric LT recipients with ALF.

The optimal immunosuppressive protocol for the portal vein infusion of PGE1 and methylprednisolone in pediatric liver transplantation for fulminant hepatic failure of unknown etiology

“…Indeterminate etiologies might explain a regional discrepancy in the survival of LTx recipients and in the incidence of severe rejection. In contrast to several Japanese groups , Ganschow et al. and Miloh et al.…”

“…Our single attempt to use Simulect was disappointing; however, a recent report from Shigeta et al. that demonstrated the effectiveness of an IL‐2 receptor antagonist for patients with steroid‐resistant rejection was encouraging .…”

“…LTx has been established as an option for the treatment of FHF in pediatric patients. While the long‐term survival rate of cholestatic disease patients and most metabolic disease patients who undergo LTx has been excellent (>85%) , the overall survival rate of FHF patients who undergo LTx is considered to be unsatisfactory . Of note, an age of <1 yr and FHF of indeterminate etiology have been recognized as potential risk factors among FHF patients who undergo LTx and may explain the inferior survival outcomes .…”

Serostatus following live attenuated vaccination administered before pediatric liver transplantation

“…The corticosteroid was tapered from 1.0 to 0.3 mg/kg/day during the first month and was withdrawn within the first 3 months. Mycophenolate mofetil (MMF) was administered when patients showed TAC‐associated side effects or steroid‐resistant refractory rejection …”

Advances in pharmacotherapy to treat kidney transplant rejection

“…Non-controlled case studies [169][170][171] Increase incidence of ABMR [172][173][174] Anti-IL-2 receptor mab Low evidence level [177,180] Low level in pediatric liver transplantation [178,179] ----…”