Is acute rejection deleterious to long-term liver allograft function?

Area of Science:

• Hepatology
• Transplantation immunology
• Clinical research

Background:

• Chronic rejection is decreasing after liver transplantation, necessitating new endpoints to evaluate long-term outcomes.
• Acute rejection episodes are common after liver transplantation.
• Assessing the long-term impact of resolved acute rejection on liver allograft function is crucial.

Purpose of the Study:

• To determine the effects of resolved acute rejection episodes on late liver allograft function.
• To identify potential predictors of long-term graft outcomes following acute rejection.

Main Methods:

• Prospective analysis of hepatic function parameters in 170 adult liver transplant recipients.
• Annual work-up including liver biochemistry, indocyanine green and sulfobromophthalein clearances, and histology.
• Mean follow-up duration of 3.7 years.

Main Results:

• 51% of patients experienced acute rejection; 4.1% experienced chronic rejection.
• No significant difference in graft function was observed between patients with a single acute rejection episode and those without rejection.
• Recurrent acute rejection (n=30) led to significantly impaired liver function tests, reduced dye clearances, and more severe histologic damage compared to no rejection (n=84) or single rejection (n=56).

Conclusions:

• Single episodes of acute rejection do not negatively impact long-term liver allograft function.
• Recurrent acute rejection episodes result in lasting damage to the liver allograft.
• Findings support adjusting immunosuppressive regimens based on rejection history, potentially allowing lighter regimens for patients without rejection history.