The natural history of untreated focal allograft rejection in liver transplant recipients

✍ Scribed by McVicar, John P. ;Kowdley, Kris V. ;Bacchi, Carlos E. ;Barr, Darlene ;Marsh, Christopher L. ;Perkins, James D. ;Carithers, Robert L.

• Publisher: Wiley (John Wiley & Sons)
• Year: 1996
• Tongue: English
• Weight: 613 KB
• Volume: 2
• Category: Article
• ISSN: 1074-3022
• DOI: 10.1002/lt.500020212

✦ Synopsis

Focal rejection involves less than 20% of portal tracts in liver allograft biopsy results. The clinical significance of "focal" rejection on protocol liver biopsy results is unknown. The purpose of this study was to prospectively determine the incidence of clinically significant rejection in patients with focal rejection after orthotopic liver transplantation. Biopsy specimens from 165 consecutive transplantations in 149 patients were analyzed. After protocol biopsy specimens were obtained, patients with focal or mild rejection were observed. Fifty of 583 (8.6%) protocol biopsy results cute allograft rejection after orthotopic liver A transplant (OLT) is common, occurring in 50% to 80% of recipient^.'.^ Acute rejection is usually responsive to increased immunosuppression but may occasionally be refractory to treatment and lead to graft loss. Increased immunosuppression for acute rejection may lead to an increased incidence of infectious complication^.^ Determining the optimal level of immunosuppression necessary to prevent rejection is difficult. One suggested strategy is biopsy-guided immunosuppression,*-' in which biopsy specimens are obtained on a scheduled, protocol basis, and rejection episodes are treated according to histology. Proponents of this strategy point out that changes in liver function tests after OLT are not specific enough to diagnose rejection. In addition, rejection is diagnosed earlier when protocol biopsies are performed, allowing earlier diagnosis and treatment of acute rejection after OLT.

The histological criteria for allograft rejection have