Everolimus Rescue Treatment for Chronic Rejection After Pediatric Living Donor Liver Transplantation: 2 Case Reports

Ueno, T.; Hiwatashi, S.; Saka, R.; Yamanaka, H.; Takama, Y.; Tazuke, Y.; Bessho, K.; Okuyama, H.

doi:https://doi.org/10.1016/J.TRANSPROCEED.2018.03.079

Everolimus Rescue Treatment for Chronic Rejection After Pediatric Living Donor Liver Transplantation: 2 Case Reports

Ueno, T.; Hiwatashi, S.; Saka, R. et al.

Transplantation Proceedings, 2018, 50(9), 2872-2876

Number of Access:1,021（2025-07-22 22:08 Counts）

Identifier to cite or link to this item: https://hdl.handle.net/11094/97129

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Title	Everolimus Rescue Treatment for Chronic Rejection After Pediatric Living Donor Liver Transplantation: 2 Case Reports
Creator	NRID 1000010456957 1000010456957 ORCID 0000-0002-4639-8814 0000-0002-4639-8814 researchmap permalink ueno-pedsurg ueno-pedsurg Scopus Author ID 21743992300 21743992300 CreatorName Ueno, T.
	NRID 1000010789259 1000010789259 CreatorName Hiwatashi, S.
	NRID 1000000459190 1000000459190 ORCID 0000-0001-8960-8618 0000-0001-8960-8618 researchmap permalink sakaryuta sakaryuta CreatorName Saka, R.
	CreatorName Yamanaka, H.
	NRID 1000050467560 1000050467560 researchmap permalink tytyty_ytytyt tytyty_ytytyt CreatorName Takama, Y.
	NRID 1000010397698 1000010397698 researchmap permalink yukotazuke-osaka yukotazuke-osaka Scopus Author ID 7006109798 7006109798 ORCID 0000-0002-8335-0414 0000-0002-8335-0414 CreatorName Tazuke, Y.
	NRID 1000080423169 1000080423169 researchmap permalink KazuBe KazuBe CreatorName Bessho, K.
	NRID 1000030252670 1000030252670 researchmap permalink okuyamahiroomi okuyamahiroomi Scopus Author ID 35496082300 35496082300 ORCID 0000-0002-1347-282X 0000-0002-1347-282X CreatorName Okuyama, H.
Description	Ueno T., Hiwatashi S., Saka R., et al. Everolimus Rescue Treatment for Chronic Rejection After Pediatric Living Donor Liver Transplantation: 2 Case Reports. Transplantation Proceedings 50, 2872 (2018); https://doi.org/10.1016/J.TRANSPROCEED.2018.03.079.
Abstract	Chronic rejection (CR) remains a challenging complication after liver transplantation. Everolimus, which is a mammalian target of rapamycin inhibitor, has an anti-fibrosis effect. We report here the effect of everolimus on CR. Case 1 was a 7-year-old girl who underwent living donor liver transplantation (LDLT) shortly after developing fulminant hepatitis at 10 months of age. Liver function tests (LFTs) did not improve after transplantation despite treatment with tacrolimus + mycophenolate mofetil (MMF). Antithymoglobulin (ATG) and steroid pulse therapy were also ineffective. The patient was diagnosed with CR, and everolimus was started with a target trough level of about 5 ng/mL. LFTs improved and pathological examination showed no progression of hepatic fibrosis. Case 2 was a 10-year-old girl with Alagille syndrome who underwent LDLT at 1 year of age. She had biopsy-proven acute cellular rejection with prolonged LFT abnormalities beginning 3 years after transplantation. She was treated with steroid pulse therapy, followed by MMF, tacrolimus, and prednisolone. Her condition did not improve, even after subsequent ATG administration. CR was suspected based on liver biopsy in the fourth postoperative year, and everolimus was introduced. The target trough level was around 5 ng/mL, but was reduced to 3 ng/mL due to stomatitis. Four years have passed since the initiation of everolimus, and LFTs are stable with no progression of liver biopsy fibrosis. We describe 2 cases in which everolimus was administered for CR. In both cases, LFTs improved and fibrosis did not progress, suggesting that everolimus is an effective treatment for CR after LDLT.
Publisher	Elsevier
Source Title	Transplantation Proceedings
Volume (Issue)	50(9)
Page	2872-2876
Date of Issued	2018-11-01
Language	English
Handle URL	https://hdl.handle.net/11094/97129
PISSN	00411345
eISSN	18732623
Relation.isVersionOf	DOI (Publisher Version) https://doi.org/10.1016/J.TRANSPROCEED.2018.03.079
Access Rights	open access
CopyRight	© 2018. This manuscript version is made available under the CC-BY-NC-ND 4.0 license https://creativecommons.org/licenses/by-nc-nd/4.0/
oaire:version	Accepted Manuscript
Category	学術雑誌論文 Journal Article

Resource Type	journal article
Local Type	Journal Article
DCTERMS.bibliographicCitation	Transplantation Proceedings. 2018, 50(9), p. 2872-2876
DC.title	Everolimus Rescue Treatment for Chronic Rejection After Pediatric Living Donor Liver Transplantation: 2 Case Reports
DC.creator	Ueno, T.
	Hiwatashi, S.
	Saka, R.
	Yamanaka, H.
	Takama, Y.
	Tazuke, Y.
	Bessho, K.
	Okuyama, H.
DC.publisher	Elsevier
DC.language' scheme='DCTERMS.RFC1766	English
DCTERMS.issued' scheme='DCTERMS.W3CDTF	2018-11-01
DC.identifier	https://doi.org/10.1016/J.TRANSPROCEED.2018.03.079
DC.description	Ueno T., Hiwatashi S., Saka R., et al. Everolimus Rescue Treatment for Chronic Rejection After Pediatric Living Donor Liver Transplantation: 2 Case Reports. Transplantation Proceedings 50, 2872 (2018); https://doi.org/10.1016/J.TRANSPROCEED.2018.03.079.
DCTERMS.abstract	Chronic rejection (CR) remains a challenging complication after liver transplantation. Everolimus, which is a mammalian target of rapamycin inhibitor, has an anti-fibrosis effect. We report here the effect of everolimus on CR. Case 1 was a 7-year-old girl who underwent living donor liver transplantation (LDLT) shortly after developing fulminant hepatitis at 10 months of age. Liver function tests (LFTs) did not improve after transplantation despite treatment with tacrolimus + mycophenolate mofetil (MMF). Antithymoglobulin (ATG) and steroid pulse therapy were also ineffective. The patient was diagnosed with CR, and everolimus was started with a target trough level of about 5 ng/mL. LFTs improved and pathological examination showed no progression of hepatic fibrosis. Case 2 was a 10-year-old girl with Alagille syndrome who underwent LDLT at 1 year of age. She had biopsy-proven acute cellular rejection with prolonged LFT abnormalities beginning 3 years after transplantation. She was treated with steroid pulse therapy, followed by MMF, tacrolimus, and prednisolone. Her condition did not improve, even after subsequent ATG administration. CR was suspected based on liver biopsy in the fourth postoperative year, and everolimus was introduced. The target trough level was around 5 ng/mL, but was reduced to 3 ng/mL due to stomatitis. Four years have passed since the initiation of everolimus, and LFTs are stable with no progression of liver biopsy fibrosis. We describe 2 cases in which everolimus was administered for CR. In both cases, LFTs improved and fibrosis did not progress, suggesting that everolimus is an effective treatment for CR after LDLT.
DC.rights	© 2018. This manuscript version is made available under the CC-BY-NC-ND 4.0 license https://creativecommons.org/licenses/by-nc-nd/4.0/
DC.format	97129
citation_title	Everolimus Rescue Treatment for Chronic Rejection After Pediatric Living Donor Liver Transplantation: 2 Case Reports
citation_author	Ueno, T.
	Hiwatashi, S.
	Saka, R.
	Yamanaka, H.
	Takama, Y.
	Tazuke, Y.
	Bessho, K.
	Okuyama, H.
citation_publisher	Elsevier
citation_language	English
citation_date	2018-11-01
citation_journal_title	Transplantation Proceedings
citation_volume	50
citation_issue	9
citation_firstpage	2872
citation_lastpage	2876
citation_doi	https://doi.org/10.1016/J.TRANSPROCEED.2018.03.079
citation_public_url	https://hdl.handle.net/11094/97129

Everolimus Rescue Treatment for Chronic Rejection After Pediatric Living Donor Liver Transplantation: 2 Case Reports

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