The C0 and C2 levels at time of biopsy were 247.1 and 614. for 3C6 months, every month for 6C24 months and every 2 months after 2 2′-Deoxyguanosine years. All these cases had LDLT for other etiologies (and not for Autoimmune Hepatitis (AIH) related cirrhosis). The liver biopsy findings included interface hepatitis and plasma cell rich infiltrate in all, rejection activity index was 3 in all patients, 2 had Ishak’s grade 1C2 fibrosis and 2 had grade 4 fibrosis. These patients received following doses of prednisolone after diagnosis of DAIH; 60?mg once a day for 1 week, 50?mg for 1 week, 40?mg for 1 week, 30?mg for 1 week, 25?mg for 1 week, 20?mg for 1 week, 15?mg for 2 weeks and slow taper to 10?mg once a day as advised by European 2′-Deoxyguanosine Association for the Study of the Liver guidelines.1 Half dose of steroid was used in one patient where azathioprine was also used. The prednisolone was continued at 10?mg per day. We aimed to keep Tac level of 5C8 after diagnosis of DAIH. The details of each case are given below and in Table 1. Table 1 Characteristics of 4 Patients. thead th align=”left” rowspan=”1″ colspan=”1″ S. no. /th th align=”center” rowspan=”1″ colspan=”1″ Age, sex /th th align=”center” rowspan=”1″ colspan=”1″ Pre LT diagnosis /th th align=”center” rowspan=”1″ colspan=”1″ DAIH diagnosed after LDLT (months) /th th align=”center” rowspan=”1″ colspan=”1″ AST/ALT at time of biopsy /th th align=”center” rowspan=”1″ colspan=”1″ Positive auto-antibody post-LT /th th align=”center” rowspan=”1″ colspan=”1″ Total IgG mg/dl /th th align=”center” rowspan=”1″ colspan=”1″ Treatment modification /th th align=”center” rowspan=”1″ colspan=”1″ AST/ALT at follow up /th /thead 149 MAlcoholic8161/63ANA 1:3201853Azathioprine, prednisolone48/39 at 3 months234 MCryptogenic75179/125ANA 1:402743Prednisolone24/27 at 2 months359 MAlcoholic9149/106SMA 1:202860Prednisolone36/23 at 8 months451 MNon-alcoholic steatohepatitis38412/264ANA 1:3203804Prednisolone, increased tacrolimus dose34 and 51 at 4 months Open in a separate windows Case 1 A 49-12 months old male had LDLT in August 2010 for alcohol related decompensated cirrhosis. His donor was 47-12 months aged wife. 2′-Deoxyguanosine He was doing well till May 2017 when a liver biopsy was done for raised transaminases (Aspartate Aminotransferase [AST] and Alanine Aminotransferase [ALT] were 61 and 63 2′-Deoxyguanosine respectively, Gamma Glutamyl Transpeptidase [GGT] and Alkaline Phosphatase [ALP] were 74 and 138 respectively). He had no comorbidities. He was on tacrolimus at the time of diagnosis, Tac level was 9 at the time of liver biopsy. He was started on 30?mg prednisolone and 50?mg azathioprine and he improved with these modifications to immunosuppressive medications as shown in Table 1. Case 2 A 34-12 months aged male underwent LDLT for cryptogenic cirrhosis in December 2010; his 30-12 months old brother was donor. He had hypertension before liver transplantation and developed diabetes mellitus after LDLT. He had seizures in post-operative period and tacrolimus was converted to cyclosporine. His investigations were normal till February 2017 when he had raised LFTs; a liver biopsy was done which suggested DAIH. The C0 and C2 levels at time of biopsy were 247.1 and 2′-Deoxyguanosine 614. His LFTs improved with addition of prednisolone. Case 3 A 59-12 months aged male underwent LDLT for decompensated alcoholic cirrhosis in April 2015. He had diabetes as comorbidity. A liver biopsy was done in January 2016 for raised LFTs which were consistent with DAIH. His Tac level was 6 at the time of diagnosis. He was given steroids. He had orbital mucormycosis which necessitated orbitotomy in May 2016. He was kept on 20?mg prednisolone only during recovery from contamination and tacrolimus was added later. His liver function test remained stable on tacrolimus and 5?mg prednisolone. Case 4 A 51-12 months aged male underwent LDLT for decompensated cirrhosis for alcoholic liver disease in December 2013; his donor was 43-12 months old brother. He had anastomotic biliary stricture for which Endoscopic Retrograde Cholangiopancreatography (ERCP) was done and remodeled stricture status was achieved in 2015. He was doing well till January 2017 when a liver biopsy was done for raised LFTs. The liver biopsy was consistent with DAIH. He was on tacrolimus and mycophenolate at the time of biopsy and tacrolimus level was 5.2. His tacrolimus dose was increased and steroids were added, his LFTs improved gradually. He had near normalization of LFTs at 4 Rabbit Polyclonal to PML months with a tacrolimus level of 8.6?ng/ml and low dose steroids. Discussion All these cases had extensive work up for other causes of post-transplant raised liver function assessments (surface antigen of hepatitis.
The C0 and C2 levels at time of biopsy were 247