Background : High MELD increased, we cann’t use enough immunosuppressant due to sepsis fear. When we meet SRAR, we usually plan to re-transplantation. I reported the first case of ATG use after SRAR in AMC

Methods : The medical records were reviewed.

Results : 47 year old men did Desead donor Liver Transplantation due to alcoholic liver cirrhosis. At that time His mentality was drowsy and MELD score was 39. Intra-operative steroid injection was 3mg/kg. He discharge POD #67. When He discharged, his FK TDM was 3.6ng/ml. when he come to the center for regular check His total bilirubin elevated, we did liver biopsy at POD#134 The pathology reported Acute cellular rejection (ACR) (RAI=7). We high dose steroid therapy with FK level above >10ng/ml. His liver function not recovery and we did rebiopsy on POD#144 The pathology reported also ACR (RAI=7). His general condition was good so we decided try to ATG therapy. Before injected the ATG, We check chest CT for rule out pneumonia, we planned to ATG 1.5mg/kg for 12hr. we check CD 3 count before injection and 3rd day and 6th day. CD 3 count was below 25, we stop injection after 7th ATG injection. After injection He feel chilling at first day after then He did well. Finish injection 7days,. Although inject ATG, the patient’s liver function was aggravated we plan to re-transplantation.

Conclusions : unfortunately my 1st experience did not success. But He did not suffer from thymoglobulin side effect. We know the ATG was tolerable used in LT patient.