Late hepatic allograft dysfunction

Abstract

Key Points1. Lifelong monitoring of graft function, immunosuppressive levels, and screening for drug toxicity is required in all liver recipients.2. Late hepatic allograft dysfunction is common and is caused by a variety of etiologies including rejection, infection, biliary/vascular abnormalities, recurrence of disease, and drug hepatotoxicity.3. In all patients with late hepatic allograft dysfunction, liver biopsy should be performed to assess for the presence of rejection, and to thus avoid excessive use of bolus corticosteroid therapy and guide appropriate immunosuppressive management.4. Recurrence of disease is the most common cause of late hepatic allograft dysfunction.5. Hepatitis C universally reinfects the hepatic allograft, and is associated with decreased patient and graft survival and leads to the recurrence of cirrhosis in 28% of patients within 5 years of transplantation.

The associations of IL-18 serum levels and promoter polymorphism with tacrolimus pharmacokinetics and hepatic allograft dysfunction in Chinese liver transplantation recipients

“…Among all the recipients, there are 14 recipients that had hepatic allograft dysfunction after transplantation. The hepatic allograft dysfunction is defined as increasing or persistent elevations in serum levels of ALT, ALP or bilirubin (greater than two times the upper limit of normal) (Wiesner and Menon, 2001). All liver transplantation recipients volunteered for the study and gave written informed consent.…”

The roles and potential therapeutic implications of CXCL4 and its variant CXCL4L1 in the pathogenesis of chronic liver allograft dysfunction

“…Risk factors associated with the development of recurrent AIH include suboptimal immunosuppression, HLA phenotype, disease type and severity in the native liver, and duration of follow-up. Among these factors, steroid withdrawal is the most common cause of AIH [76]. The putative mechanisms leading to this condition include the repopulation of the allograft with recipient antigen-presenting cells, the presence of primed promiscuous cytotoxic T cells within the recipient, and immune reactions to liver cell antigens that trigger molecular mimicry [77].…”

A Neural Network Approach to Predict Acute Allograft Rejection in Liver Transplant Recipients Using Routine Laboratory Data

“…Despite the development and improvement of immunosuppressive regimens and surgical techniques in the last decades, acute rejection (AR) still remains of fundamental problems in 10% -20% of liver transplant (LT) patients and it is more common in the first few weeks posttransplantation. AR episodes are distinguished in 34% to 70% of patients, and 5% to 20% of patients will result in chronic rejection (CR), which is usually irreversible and needs re-transplantation (5)(6)(7)(8)(9). Currently, liver biopsy is a widely used gold standard for the examination of the rejection in liver transplant patients.…”