caa a22 4500 477036198 CHVBK 20180405111305.0 cr unu---uuuuu 170330e19961001xx s 000 0 eng 10.1007/s002689900160 doi (NATIONALLICENCE)springer-10.1007/s002689900160 Management of Acute Steroid-Resistant Rejection after Liver Transplantation [Elektronische Daten] [Klaus-Peter Platz, Andrea R. Mueller, Michael Zytowski, Peter Lemmens, Hartmut Lobeck, Peter Neuhaus] Abstract. Prior to the FK506 era, OKT3 was primarily used for treatment of steroid-resistant rejection. Initially FK506 has been used as a last treatment of refractory acute or chronic rejection. We provide strong evidence that the use of FK506 is more successful if rescue therapy is performed early instead of using it as the last resort. Between September 1988 and March 1995 a total of 600 liver transplantations were performed in 550 patients. Of these 550 patients, 426 received primarily cyclosporine A (CsA)-based immunosuppression. Of the 426 CsA patients, 70 (16.4%) required either FK506 (51.4%), or OKT3 rescue therapy (27.1%), or a combination of the two drugs (21.5%). The latter group of patients received first OKT3 and then FK506 rescue when OKT3 therapy failed. Treatment was initiated simultaneously (within 1 week) in 11 patients, and 4 patients received FK506 rescue later during the course of rejection. The highest success rates (88.9%) were observed in patients given FK506 rescue therapy. Retransplantation was necessary more often in patients receiving OKT3 than in those with FK506 rescue therapy (15.8% versus 5.5%, respectively). Retransplantation and death due to chronic rejection increased with the need for additional FK506 rescue therapy after OKT3 failure. This increase was most pronounced in patients receiving FK506 during the late course of rejection, reaching a failure rate of 75.0% (50.0% of deaths were due to chronic rejection). The lowest incidence of cytomegalovirus infection and of infectious, neurologic, and renal complications was observed in the FK506 rescue group. We conclude that early FK506 rescue therapy may be the treatment of choice for acute steroid-resistant rejection.: 1996 by the Société Internationale de Chir, ugie Platz Klaus-Peter Department of Surgery, Virchow Clinic, Humboldt University Berlin, Augustenburger Platz 1, 13353 Berlin, Germany, DE aut Mueller Andrea R. Department of Surgery, Virchow Clinic, Humboldt University Berlin, Augustenburger Platz 1, 13353 Berlin, Germany, DE aut Zytowski Michael Department of Surgery, Virchow Clinic, Humboldt University Berlin, Augustenburger Platz 1, 13353 Berlin, Germany, DE aut Lemmens Peter Department of Surgery, Virchow Clinic, Humboldt University Berlin, Augustenburger Platz 1, 13353 Berlin, Germany, DE aut Lobeck Hartmut Department of Pathology, Virchow Clinic, Humboldt University Berlin, Augustenburger Platz 1, 13353 Berlin, Germany, DE aut Neuhaus Peter Department of Surgery, Virchow Clinic, Humboldt University Berlin, Augustenburger Platz 1, 13353 Berlin, Germany, DE aut https://doi.org/10.1007/s002689900160 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s002689900160 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Platz Klaus-Peter Department of Surgery, Virchow Clinic, Humboldt University Berlin, Augustenburger Platz 1, 13353 Berlin, Germany, DE aut NATIONALLICENCE 700 1- Mueller Andrea R. Department of Surgery, Virchow Clinic, Humboldt University Berlin, Augustenburger Platz 1, 13353 Berlin, Germany, DE aut NATIONALLICENCE 700 1- Zytowski Michael Department of Surgery, Virchow Clinic, Humboldt University Berlin, Augustenburger Platz 1, 13353 Berlin, Germany, DE aut NATIONALLICENCE 700 1- Lemmens Peter Department of Surgery, Virchow Clinic, Humboldt University Berlin, Augustenburger Platz 1, 13353 Berlin, Germany, DE aut NATIONALLICENCE 700 1- Lobeck Hartmut Department of Pathology, Virchow Clinic, Humboldt University Berlin, Augustenburger Platz 1, 13353 Berlin, Germany, DE aut NATIONALLICENCE 700 1- Neuhaus Peter Department of Surgery, Virchow Clinic, Humboldt University Berlin, Augustenburger Platz 1, 13353 Berlin, Germany, DE aut Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer