Từ chối của allograft gan mãn tính có rất nhiều cái tên: từ chối mãn tính ductopenic, biến mất hội chứng ống mật, từ chối mãn tính. Ductopenic từ chối mãn tính có thể dẫn đến mất ghép. Nó được điều trị ức chế miễn dịch gia tăng, bao gồm cả chuyển đổi để tacrolimus từ cyclosporin hoặc chuyển sang sirolimus. | Immunosuppression after Liver Transplantation 71 Treatment of Chronic Rejection Chronic rejection of the liver allograft has many names chronic ductopenic rejection vanishing bile duct syndrome chronic rejection. Chronic ductopenic rejection may lead to loss of the graft. It is treated by increased immunosuppression including conversion to tacrolimus from cyclosporin or switching to Sirolimus. Withdrawal of Immunosuppression The observation that some patients have maintained long-term good graft function after discontinuing immunosuppression has led some centers to embark on carefully controlled trials of withdrawal of all immunosuppression in long-term 5 years survivors with good graft function or in subjects with major impediments to continued use of immunosuppressant such as malignant disease. These studies have demonstrated that it is possible to withdraw all immunosuppression in about- 20 of carefully selected patients. The remainder required maintenance immunosuppressants or their reintroduction if they had been stopped. The usual reason for failure to withdraw immunospressants was late onset acute cellular rejection which was then controlled by adjusted phamacotherapy. Those recipients grafted for non-autoimmune diseases without episodes of acute rejection and with a good HLA match are more likely to be able to withdraw immunosuppression. 6 Side-Effects of Immunosuppression The side-effects of immunosuppression may be due either to The effect of immunosuppression itself especially infection and malignancy The effects of individual drugs These are discussed in detail in Chapter 9. Tailoring the Immunosuppression to the Individual Since different drugs have differing effects and side-effects both on the patient and the disease it is important not to adopt one regime for all patients but to tailor the drug regime for the individual. The probability of developing acute rejection is in part dependent on the indication for transplantation so that patients grafted
