Acute phase proteins and liver allograft rejection

We studied the sequential changes in the positive acute phase reactants orosomucoid, alpha 1-antichymotrypsin, alpha 1-antitrypsin, haptoglobin and C-reactive protein, and in the negative acute phase reactant, prealbumin, as well as in alpha 2-macroglobulin and beta 2-microglobulin in serum following orthotopic liver transplantation in nine adult patients. Synchronous increases in all five positive acute phase reactants were observed in association with acute liver rejection episodes; the elevations were statistically significant for orosomucoid and alpha 1-antichymotrypsin. In four out of nine well-documented rejection episodes C-reactive protein did not increase at all. Marked variations occurred in post-transplant prealbumin and alpha 2-macroglobulin levels; both proteins tended to decrease 2-3 days after the rejection was diagnosed. The circulating levels of beta 2-microglobulin were raised during the post-transplant period and markedly increased in association with acute graft rejection episodes. The results demonstrate marked changes in plasma protein concentrations in association with acute liver allograft rejection episodes; the kinetics of serum acute phase reactants is very similar to that found in inflammation and tissue injury in general.