Rejection vs dosage cycle

[rbahuguna]

My mother had liver transplant two years back. She had chronic liver problem (liver scan showed rough surface) before transplant but had no HCV. For the last one year, her liver enzymes have been very high (GGT can touch 1800, for example). When that happens, the doctor increases PanGraf / Cellcept dosage and a particular steroid (wysolone). After that  the enzymes go back to normal - except GGT which goes down but still remains well above normal (say, falls from 1800 to 300). This has become a two-monthly cycle: liver enzymes shoot up, her doctor increases dosage, this is followed by decrease in enzyme levels in next monthly blood test, then doctor slowly decreases dosage, this is always followed by increase in liver enzyme level, and so on. This has been going on for an year now

I am thinking if increased dose reduces enzyme level, then why decrease the dosage at all. Is it only fear of side-effect?

BTW, we talk with only one particular doctor (in the liver transplant team) who is also head of the team. And that  mother's dosage basically comprises PanGraf, wysolone (steroid) and cellcept. During the above mentioned cycle, wysolone dose varies between 0 to 20 mg a day. PanGraf varies between 2 to three mg (twice) and CellCept between 500 to 750 mg a day (twice, I if I can remember correctly)

[rbahuguna]

Your response is re-assuring. Few days back the doctor had prescribed CT Scan to assess dialation of intra hepatic ...biliary ... That test turned out negative - i.e. no dialation, and liver is smooth

[Thomas D Schiano, MD]

sorry for the delay in responding--there was a glitch in the system

one should be on as low a dose of immunosuppreesion ultimately as possible to decrease potential side effects.  i agree with what they are doing so far