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Kerkar N, Dugan C, Rumbo C, Morotti RA, Gondolesi G, Shneider BL,
Emre S.
Am J Transplant. 2005 May;5(5):1085-9.
Rapamycin successfully treats post-transplant autoimmune
hepatitis.
Recanati Miller Transplant Institute, Department of Pediatrics,
Division of Pediatric Hepatology, The Mount Sinai School of Medicine, New York,
NY, USA.
Rapamycin (Rapa), one of the newer immunosuppressants has been
found to control and prevent autoimmune features in animal models. This is the
first report describing the successful control of post-transplant autoimmune
hepatitis (AIH) with Rapa. Post-transplant AIH is diagnosed in the presence of
raised transaminases, elevated immunoglobulin G, presence of autoantibodies and
histologic changes consistent with AIH on liver biopsy. It may represent a
recurrence of the original AIH that led to transplantation or present as a de
novo AIH after liver transplant. Post-transplant AIH has conventionally been
treated with Prednisolone (Pred) and Azathioprine (AZA). In this report,
tailoring of immunosuppression after diagnosis of post-transplant AIH is
described with special emphasis on those treated successfully with Rapa. Fifteen
of 21 patients responded to treatment with an increase in dose of Pred and
addition of AZA or Mycophenolate Mofetil (MMF) to calcineurin inhibitor. Five
non-responders and one other patient with post-transplant AIH were treated with
addition of Rapa. All six responded to treatment but drug was withdrawn in one
patient. Adverse events were minimal. Rapa may prove to be an important addition
in the control of autoimmune liver disease.
PMID: 15816890
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