Late Recurrent Post-Transplant Primary Biliary Cirrhosis in British Columbia
Late recurrent primary biliary cirrhosis (PBC) following orthotopic liver transplant remains a controversial topic. The first documented case of recurrence occurring in 16 patients transpl...
Saved in:
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
1997-01-01
|
| Series: | Canadian Journal of Gastroenterology |
| Online Access: | http://dx.doi.org/10.1155/1997/790906 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850236736221741056 |
|---|---|
| author | Eric M Yoshida R Andrew Singh Robert K Vartanian David A Owen Siegfried R Erb Charles H Scudamore |
| author_facet | Eric M Yoshida R Andrew Singh Robert K Vartanian David A Owen Siegfried R Erb Charles H Scudamore |
| author_sort | Eric M Yoshida |
| collection | DOAJ |
| description | Late recurrent primary biliary cirrhosis (PBC) following orthotopic liver transplant remains a controversial topic. The first documented case of recurrence occurring in 16 patients transplanted for PBC and followed at the authors' institution for longer than one year is presented. A 54-year-old man transplanted for PBC developed a cholestatic pattern of enzyme elevation on post-transplant day (PTD) 1305. Repeat antimitochondrial antibody was strongly positive (1:300 to 1:400). A liver biopsy revealed severe bile duct damage, lymphocytic cholangitis, focal periductal noncaseating granuloma and minimal endotheliitis. Recurrent PBC was diagnosed. At the time of orthotopic liver transplant this patient received induction immunosuppression with OKT3 crossed over to cyclosporine (CsA), azathioprine (AZA) and prednisone. AZA was discontinued early and maintenance CsA tapered to a target trough level of 150 to 200 ng/mL by PTD 365. Prednisone was withdrawn by PTD 664. CsA levels during PTDs 1225 to 1305 (before elevation of hepatobiliary enzymes) were below target at 114 to 166 ng/mL. Of the 16 patients, all but three were maintained on CsA, AZA and prednisone. One was on CsA (trough levels on target) and AZA; the other two, including the patient with recurrent PBC, were on CsA only. The trough CsA level of the patient without recurrent PBC has been within the target range. The authors speculate that the underlying defect in immunoregulation in PBC persists post-transplant and that in the patient without recurrent PBC this defect was unmasked by lowered maintenance immunosuppression - allowing recurrence of PBC in a previously stable liver allograft. |
| format | Article |
| id | doaj-art-1166fb45f1a44a6785f99cdec6058d49 |
| institution | OA Journals |
| issn | 0835-7900 |
| language | English |
| publishDate | 1997-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Canadian Journal of Gastroenterology |
| spelling | doaj-art-1166fb45f1a44a6785f99cdec6058d492025-08-20T02:01:54ZengWileyCanadian Journal of Gastroenterology0835-79001997-01-0111322923310.1155/1997/790906Late Recurrent Post-Transplant Primary Biliary Cirrhosis in British ColumbiaEric M Yoshida0R Andrew Singh1Robert K Vartanian2David A Owen3Siegfried R Erb4Charles H Scudamore5Departments of Medicine, Anatomic Pathology, and Surgery, University of British Columbia, CanadaDepartments of Medicine, Anatomic Pathology, and Surgery, University of British Columbia, CanadaDepartments of Medicine, Anatomic Pathology, and Surgery, University of British Columbia, CanadaDepartments of Medicine, Anatomic Pathology, and Surgery, University of British Columbia, CanadaBritish Columbia Transplant Society, Vancouver, British Columbia, CanadaDepartments of Medicine, Anatomic Pathology, and Surgery, University of British Columbia, CanadaLate recurrent primary biliary cirrhosis (PBC) following orthotopic liver transplant remains a controversial topic. The first documented case of recurrence occurring in 16 patients transplanted for PBC and followed at the authors' institution for longer than one year is presented. A 54-year-old man transplanted for PBC developed a cholestatic pattern of enzyme elevation on post-transplant day (PTD) 1305. Repeat antimitochondrial antibody was strongly positive (1:300 to 1:400). A liver biopsy revealed severe bile duct damage, lymphocytic cholangitis, focal periductal noncaseating granuloma and minimal endotheliitis. Recurrent PBC was diagnosed. At the time of orthotopic liver transplant this patient received induction immunosuppression with OKT3 crossed over to cyclosporine (CsA), azathioprine (AZA) and prednisone. AZA was discontinued early and maintenance CsA tapered to a target trough level of 150 to 200 ng/mL by PTD 365. Prednisone was withdrawn by PTD 664. CsA levels during PTDs 1225 to 1305 (before elevation of hepatobiliary enzymes) were below target at 114 to 166 ng/mL. Of the 16 patients, all but three were maintained on CsA, AZA and prednisone. One was on CsA (trough levels on target) and AZA; the other two, including the patient with recurrent PBC, were on CsA only. The trough CsA level of the patient without recurrent PBC has been within the target range. The authors speculate that the underlying defect in immunoregulation in PBC persists post-transplant and that in the patient without recurrent PBC this defect was unmasked by lowered maintenance immunosuppression - allowing recurrence of PBC in a previously stable liver allograft.http://dx.doi.org/10.1155/1997/790906 |
| spellingShingle | Eric M Yoshida R Andrew Singh Robert K Vartanian David A Owen Siegfried R Erb Charles H Scudamore Late Recurrent Post-Transplant Primary Biliary Cirrhosis in British Columbia Canadian Journal of Gastroenterology |
| title | Late Recurrent Post-Transplant Primary Biliary Cirrhosis in British Columbia |
| title_full | Late Recurrent Post-Transplant Primary Biliary Cirrhosis in British Columbia |
| title_fullStr | Late Recurrent Post-Transplant Primary Biliary Cirrhosis in British Columbia |
| title_full_unstemmed | Late Recurrent Post-Transplant Primary Biliary Cirrhosis in British Columbia |
| title_short | Late Recurrent Post-Transplant Primary Biliary Cirrhosis in British Columbia |
| title_sort | late recurrent post transplant primary biliary cirrhosis in british columbia |
| url | http://dx.doi.org/10.1155/1997/790906 |
| work_keys_str_mv | AT ericmyoshida laterecurrentposttransplantprimarybiliarycirrhosisinbritishcolumbia AT randrewsingh laterecurrentposttransplantprimarybiliarycirrhosisinbritishcolumbia AT robertkvartanian laterecurrentposttransplantprimarybiliarycirrhosisinbritishcolumbia AT davidaowen laterecurrentposttransplantprimarybiliarycirrhosisinbritishcolumbia AT siegfriedrerb laterecurrentposttransplantprimarybiliarycirrhosisinbritishcolumbia AT charleshscudamore laterecurrentposttransplantprimarybiliarycirrhosisinbritishcolumbia |