Abstract
A 4.5-year-old boy underwent liver transplantation. The spleen was saved. Immunosuppression was started with tacrolimus and methylprednisolone. Disorders in a liver function test appeared on post-operative day (POD) 7. We made a diagnosis of acute cellular rejection. Nevertheless the result of a liver function test (LFT) showed no reaction in spite of repeated steroid therapy. Jaundice was prolonged and massive ascites remained. Pathological findings of liver needle biopsy on POD 20 and 26 persisted in severe graft damage, so-called early chronic rejection. From the view point of responsiveness to therapy, coagulopathy and protein-losing ascites, 3mg/body of OKT3 was administrated from POD 24 and the dose of OKT3 was escalated to 5mg/body from POD 29. Temporal rebound in the liver function test appeared after the withdrawal of muromonab-CD3; thereafter disorders of LFT were normalized. Ascites and jaundice also disappeared, and clinical findings clearly improved. Pathological findings of liver needle biopsy on POD 47 and 61 certified drastic recovery of severe graft damages. We here presented a rare case of early chronic rejection after pediatric liver transplantation, successfully treated by OKT3.
