Acute cellular rejection after liver transplantation: variability, morbidity, and mortality

Area of Science:

• Hepatology
• Transplantation Immunology
• Clinical Pathology

Background:

• Acute cellular rejection (ACR) is a significant complication following liver transplantation.
• The precise incidence and impact of ACR on patient outcomes remain incompletely understood.

Purpose of the Study:

• To investigate the reported incidence of ACR across transplant centers.
• To evaluate the effect of ACR on patient morbidity (hospitalization duration) and mortality.

Main Methods:

• A systematic review of 18 studies involving 1,437 liver transplant recipients was conducted.
• Data on ACR incidence, diagnostic criteria (Snover's criteria), immunosuppressive regimens (cyclosporine dosage), morbidity, and mortality were analyzed.

Main Results:

• The mean incidence of ACR was 49.8%, with wide variation (24%-80%) between centers.
• High-dose cyclosporine induction was associated with significantly lower ACR rates (27.0%) compared to low-dose (63.6%).
• ACR significantly increased initial hospitalization (52.4 vs. 28.3 days) and 6-month hospital days (55.6 vs. 37.7 days) but showed no correlation with mortality.

Conclusions:

• ACR incidence varies significantly among liver transplant centers, irrespective of diagnostic criteria.
• High-dose cyclosporine induction may be associated with a reduced frequency of ACR.
• While ACR does not appear to affect mortality, it substantially increases patient morbidity and healthcare costs.