mycophenolic-acid and Liver-Cirrhosis--Alcoholic

Nocardiosis is usually a disseminated disease seen in immunocompromised individuals. We herein present a rare case of isolated Nocardia liver abscess post liver transplantation. The patient responded well to treatment and is on long-term antibiotics for Nocardia infection.

Topics: Anti-Bacterial Agents; End Stage Liver Disease; Glucocorticoids; Humans; Immunocompromised Host; Immunosuppression Therapy; Immunosuppressive Agents; Liver Abscess; Liver Cirrhosis, Alcoholic; Liver Transplantation; Male; Middle Aged; Mycophenolic Acid; Nocardia; Nocardia Infections; Paracentesis; Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization; Tacrolimus; Tomography, X-Ray Computed; Trimethoprim, Sulfamethoxazole Drug Combination; Ultrasonography, Doppler; Ultrasonography, Interventional

Topics: Delayed Diagnosis; Herpesvirus 8, Human; Humans; Immunocompromised Host; Immunosuppressive Agents; Liver Cirrhosis, Alcoholic; Liver Transplantation; Male; Middle Aged; Mycophenolic Acid; Postoperative Complications; Sarcoma, Kaposi; Skin Neoplasms; Tacrolimus; Thorax

We reported a case of vasculitis of anti-neutrophil cytoplasmic antibody after liver transplantation. A 56-year-old male patient underwent orthotopic liver transplantation of the classic style on February 25, 2010 because of alcoholic cirrhosis.. Pathology analysis showed it was nodular cirrhosis. The patient was given conventional treatment programs of FK (tacrolimus) + mycophenolate mofetil + hormone; hormone was suspended at the third month. He began to cough and spit, and there was blood in the sputum in September. Lung CT scanning images showed that there was a visible multiple low-density patchy shadow in both lungs; however, a number of other detecting results were negative.. Considering the patient with contact suspected mold, we improved the inspection and switched to experimental treatment (itraconazole), and the patient improved and was then discharged. Two months later, he complained about appearing hemoptysis. Final diagnostic results showed it was anti-neutrophil cytoplasmic antibody-associated vasculitis after liver transplantation. Then we stopped medication with itraconazole. Treatment with methylprednisolone was continued, and the patient gradually stopped coughing and had no expectoration and hemoptysis.. Reviewing CT respectively showed significant improvement at the 7th and 24th days of hormone therapy; thus, we confirmed it was anti-neutrophil cytoplasmic antibody-associated vasculitis after liver transplantation.

Topics: Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis; Antibodies, Antineutrophil Cytoplasmic; Diagnosis, Differential; Humans; Liver Cirrhosis, Alcoholic; Liver Transplantation; Lung Diseases; Male; Methylprednisolone; Middle Aged; Mycophenolic Acid; Postoperative Complications; Tomography, X-Ray Computed

We present the case of a liver transplant recipient with alcoholic liver cirrhosis and early-stage hepatocellular carcinoma who developed biopsy-proven acute steroid-resistant rejection 3 months after liver transplantation. After the failure of immunosuppressive therapy with intravenous boluses of 6-methyl-prednisolone and switching of the immunosuppressive regimen to tacrolimus plus mycophenolate mofetil, two doses of intravenous basiliximab were administered four days apart. Clinical, analytical, and biopsy-proven histological response was complete. No basiliximab-related adverse events were detected. Basiliximab may represent an alternative in liver transplantation immunosuppression to treat acute steroid-resistant rejection, without increasing the incidence of infections, neoplasms, or other adverse events, as shown by this case.

Topics: Acute Disease; Antibodies, Monoclonal; Basiliximab; Carcinoma, Hepatocellular; Cyclosporine; Drug Resistance; Graft Rejection; Humans; Immunosuppressive Agents; Liver Cirrhosis, Alcoholic; Liver Function Tests; Liver Neoplasms; Liver Transplantation; Male; Methylprednisolone; Middle Aged; Mycophenolic Acid; Pregnenediones; Receptors, Interleukin-2; Recombinant Fusion Proteins; Tacrolimus

Nephrotoxicity is one of the most common side effects of long-term immunosuppressive therapy with calcineurin inhibitors. We describe a case of distal renal tubular acidosis secondary to tacrolimus administration. A 43-year-old man with end-stage liver disease due to hepatitis C and B virus infections and alcoholic cirrhosis received a liver transplantation under immunosuppressive treatment with tacrolimus and mycophenolate mofetil. In the postoperative period, the patient developed hyperkalemic hyperchloremic metabolic acidosis, with a normal serum anion gap and a positive urinary anion gap, suggesting distal renal tubular acidosis. We excluded other causes of hyperkalemia. Administration of intravenous bicarbonate, loop diuretics, and oral resin exchanger corrected the acidosis and potassium levels. Distal renal tubular acidosis is one of several types of nephrotoxicity induced by tacrolimus treatment, resulting from inhibition of potassium secretion in the collecting duct. Treatment to correct the acidosis and hyperkalemia should be promptly initiated, and the tacrolimus dose adjusted when possible.

Topics: Acidosis, Renal Tubular; Administration, Oral; Adult; Bicarbonates; Cation Exchange Resins; Drug Therapy, Combination; Humans; Hyperkalemia; Immunosuppressive Agents; Liver Cirrhosis, Alcoholic; Liver Transplantation; Male; Mycophenolic Acid; Polystyrenes; Sodium Potassium Chloride Symporter Inhibitors; Tacrolimus; Treatment Outcome

Posterior leukoencephalopathy due to calcineurin-inhibitor-related neurotoxicity is a rare but severe complication that results from treatment with immunosuppressive agents (primarily those administered after a liver or kidney transplant). The pathophysiologic mechanisms of that disorder remain unknown.. We report the case of a 46-year-old woman who received a liver transplant in our center as treatment for alcoholic cirrhosis and in whom either a fulminant course of posterior leukoencephalopathy or posterior reversible encephalopathy syndrome developed 110 days after transplant. After an initially uneventful course after the transplant, the patient rapidly fell into deep coma.. Cerebral MRI scan showed typical signs of enhancement in the pontine and posterior regions. Switching the immunosuppressive regimen from tacrolimus to cyclosporine did not improve the clinical situation. The termination of treatment with any calcineurin inhibitor resulted in a complete resolution of that complication.. Posterior reversible encephalopathy syndrome after liver transplant is rare. We recommend a complete cessation of any calcineurin inhibitor rather than a dose reduction.

Topics: Calcineurin Inhibitors; Coma; Cyclosporine; Female; Humans; Immunosuppressive Agents; Liver Cirrhosis, Alcoholic; Liver Transplantation; Magnetic Resonance Imaging; Middle Aged; Mycophenolic Acid; Posterior Leukoencephalopathy Syndrome; Prednisolone; Tacrolimus; Time Factors

Topics: Aged; Antilymphocyte Serum; Azathioprine; Cyclosporine; Female; Graft Rejection; Hepatitis; Humans; Immunosuppressive Agents; Liver Cirrhosis; Liver Cirrhosis, Alcoholic; Liver Transplantation; Male; Methylprednisolone; Middle Aged; Mycophenolic Acid; Prednisone