Severe vasculitis and autoimmune hemolytic anemia in two patients immunosuppressed for orthotopic liver graft

Out of 77 patients whom we followed for up to 7 years after orthotopic liver transplant, 2 cases (2.5%) have recently shown clinically overt autoimmunity, presenting with hemolytic anemia and with severe vasculitis, respectively. Both patients responded dramatically to a pulse of high-dose steroids. These observations suggest that the immune system of patients treated with conventional schedules of immunesuppressors is far from controlled and can mount strong erroneous responses. When clinically overt, as in our 2 cases, these complications may be life-threatening and require costly hospitalization.