Skip to main content

Table 1 Evolution of ALFTs, stages of stopping immunosuppressive drugs, and in-hospital outcomes

From: Late acute cellular rejection after switch to everolimus monotherapy at 11 months following liver transplantation

Laboratory tests (2018)

Jan 23

Mar 07

April 24

Jun 13

Sept 11

Oct 09

Oct 22

Nov 16

Dec 02

Dec 13

ALT (NR 0–55 U/L)

43

14

10

12

11

13

11

200 (H)

25

11

AST (NR 5–34 U/L)

15

12

14

15

14

18

17

91

24

18

ALP (NR 42–98 U/L)

117

57

62

71

89

82

69

801

90

86

γ-GT (NR 9–36 U/L)

134

23

12

28

11

11

10

305

30

11

Total bilirubin (NR 0–20 μmol/L)

10

9

5

7

5

5

3

16

18

7

Leukocytes (NR 4000–10,000 cells/mm3)

6900

5400

2300 (A)

2200 (B)

1800

1800

1700

4970

6.2

5.70

PMN (NR 1300–7500 cells/mm3)

-

-

287

440

455

369

643

3280

4.02

3.90

Creatinine level (NR 49–90 μmol/L)

91

115

133

160 (C)

170 (D)

178 (F)

166

171

145

138

Hemoglobin (NR12–16 g/dL)

11.4

11

10

10

9

9.4

8.6

7.8

12.5

10

Residual tacrolimus level (objective 6–10 ng/mL)

9.2

8.6

6

7.7

4.6

3.6

-

-

9.3

8.9

Residual everolimus level (objective 5–10 ng/mL)

-

-

-

-

(E)

6.4 (G)

5.7

4.5

5

5.7

  1. ALFTs abnormal liver function tests, NR normal range, ALT alanine aminotransferase, AST aspartate aminotransferase, ALP alkaline phosphate, γ-GT γ-glutamyl-transpeptidase, PMN polymorphonuclear neutrophil, Jan January, Sept September, Oct October, Nov November
  2. A: decrease Cellcept 500mg × 2/day, B: stop Cellcept, C: decrease Prograf 1.5mg × 2/day, D: decrease Prograf 1.5mg × 2/day; E: start everolimus (Certican®); F: stop Prograf; G: Certican® monotherapy; H: corticosteroid bolus + optimization of immunosuppression