Nalini Bansal, Arif Ali Khan, Manav Wadhawan, Vivek Vij
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Chronic Rejection Occurring Early Post Liver Transplant
We report the case of a 36-year-old male who was referred to us with a provisional diagnosis of ethanol-related acute on chronic liver failure with ascites, encephalopathy, and altered liver function tests (LFTs). The patient underwent a living donor liver transplant. Posttransplant, he had an uneventful recovery till postoperative day (POD) day 7 when he developed tachycardia and low-grade fever. The immunosuppression has to be withheld till POD 26. The patient later developed deranged LFT and an initial liver biopsy showed features of acute cellular rejection. He also had ongoing tachycardia; thus, immunosuppression was withheld. Subsequent to that patient developed rapid progression from progressive early to chronic rejection (CR) within 78 days posttransplant. The patient initially responded to antithymocyte globulin, but finally succumbed to fungal infection. CR usually occurs over 6 months posttransplant. The occurrence of CR was noted very early in the index patients. This case highlights the importance of a basic step-wise approach to a case post liver transplant. It also highlights the importance of specialized liver histopathology aiding in early diagnosis.
期刊介绍:
Indian Journal of Transplantation, an official publication of Indian Society of Organ Transplantation (ISOT), is a peer-reviewed print + online quarterly national journal. The journal''s full text is available online at http://www.ijtonline.in. The journal allows free access (Open Access) to its contents and permits authors to self-archive final accepted version of the articles on any OAI-compliant institutional / subject-based repository. It has many articles which include original articIes, review articles, case reports etc and is very popular among the nephrologists, urologists and transplant surgeons alike. It has a very wide circulation among all the nephrologists, urologists, transplant surgeons and physicians iinvolved in kidney, heart, liver, lungs and pancreas transplantation.