moderate rejection

My history: liver  transplant 1 year ago, had 2 moderate rejections and 1 mild since transplant. At present time having moderate rejection, recently had one portal stent and 8 Bilary ERCP's to remove stones and sludge and had stenting done, and at the present time there are no blockages. Was on Rapamune (5mg a day) prior to hernia surgery and then week before hernia surgery was put on Prograf (4mg a day) and taken off the Rapamune. I have been on Progaf since hernia surgery (8 weeks ago). Due to high billirubin reading of 28, I have been put on one Rapamune pill a day. I never had such a high reading prior to being put on Prograf, I'm going into hospital tomorrow for moderate rejection. Sine I'm on 4mg of Prograf and 1mg of Rapmune a day, could I be over medicated? Or could the Prograf that I've been on since hernia surgery be causeing high readings of billirubin and the moderate rejection?

[Thomas D Schiano, MD]

they need to treat aggressively for rejection at this point, including with thymoglobulin if necessary.  they should make sure you do not have a concurrent bile duct problem or other infection on board.  Good luck.

[Thomas D Schiano, MD]

this high bilirubin level is definitely not due to medications but is due to either acute or chronic rejection or a combination of the two, compounded by the biliary problem.  What was the reason that you needed a transplant? i think you need another liver biopsy.

[jwmich]

Had a transplant due to liver failure, doctor thinks is because of chemical exposure in work enviroment. I do not have hepatitis and I am not an alcholic. I just had a liver biospy on 6/27 and results came back as moderate rejection. I am currently in the hospital and they  are treating me with Solumedral and I think an antibioitic. Also was moved to ICU because of sugar being high, due to the steroid and was given 30 units of insulin last nite and going to have 1 more dose today. They tested biliary level today and is at 19. Doc worried that I'm going to get constricted arteries again.