Acute Rejection, Liver
GENERAL PRINCIPLES
• Many liver transplant recipients are maintained on minimal immunosuppression. Acute rejection typically occurs within the first 3 months after transplant and often in the first 2 weeks after the operation.
Acute rejection in the liver is generally reversible and does not portend as serious adverse outcomes as in other organs. Recurrent viral hepatitis is a much more frequent and morbid problem.• Liver transplant recipients commonly experience acute allograft rejection, with at least 60% having one episode.
DIAGNOSIS
Diagnosis is made by liver biopsy after technical complications are excluded.
Clinical Presentation
Manifestations can range from a slight elevation in transaminases to signs and symptoms of liver failure including fever, malaise, altered mental status, anorexia, abdominal pain, ascites, elevated bilirubin, and elevated transaminases.
Differential Diagnosis
Differential diagnosis of early liver allograft dysfunction includes primary graft nonfunction, preservation injury, vascular thrombosis, and biliary anastomotic leak or stenosis. These disorders should be excluded clinically or by Doppler ultrasonography. Causes of late allograft dysfunction include rejection, recurrent hepatitis B or C, CMV infection, EBV infection, cholestasis, or drug toxicity.