Diagnostic and predictive biomarkers of acute rejection after liver transplantation

Liver transplantation serves as a vital therapeutic intervention for individuals suffering from end-stage liver disease globally. A significant complication encountered by liver transplant recipients during the postoperative period is acute rejection, which has traditionally been identified through invasive graft biopsy procedures. Furthermore, assessing the immune status of liver transplant patients is essential for effective posttransplant management and represents a significant advancement toward the personalization of immunosuppressive therapy. Nevertheless, current immunological monitoring after the transplantation predominantly depends on clinical judgment and the measurement of immunosuppressive drug levels, lacking a comprehensive evaluation of actual immune system suppression. In contrast, biomarkers offer a comparatively novel and safer approach for the detection and prediction of transplant rejection, though their clinical application remains constrained due to the absence of prospective validation studies. This review examines the existing literature on potential biomarkers for acute rejection following liver transplantation, and their implications for clinical decision-making.