lowering rejection drugs

Based on ALT/AST continuing to rise to the 300/400 level, and not rejection but hcv, what is the general action taken.  Do you lower the prograf or cellcept and monitor closely?  What is your experience in this scenario as far as the outcome?

[Thomas D Schiano, MD]

if a liver biopsy shows that this is recurrent HCV and not rejection and antiviral teatment is not to be started, then lowering the immunosuppression somewhat is the way to go.  if interferon is to be used to treat the HCV then the immunosuppression cannot be too low or rejection will be precipitated.

[Bill200]

How does the doctor who analyzes the biopsy tell the difference between rejection and hcv inflammation?  What is the difference under the glass?

[Thomas D Schiano, MD]

the changes hould be obvious unless there are components of both seen in the same biopsy.  an expert liver pathologist is needed in these circumstances