Rejection in liver allograft recipients: Clinical characterization and management

A retrospective study of 34 liver transplants in 31 recipients receiving cyclosporine was conducted to assess the clinical features of rejection and the response to therapy. Thirty‐eight rejection episodes were identified and treated in the 34 transplants and form the material of this study. Graft dysfunction was detected by biochemical testing in most cases; clinical assessment, liver biopsy, and radiographic studies were used to establish a specific diagnosis. Rejection therapy was required in 24 of 34 transplants (71 %), occurring between 6 and 400 d after transplantation. Three days of high‐dose steroid therapy successfully reversed 19/24 (79%) first rejection episodes and and 5/14 (36%) recurrent rejections (p<0.1). Salvage therapy using anti‐lymphocyte antibody preparations reversed 4/5 first rejections and 5/8 recurrent rejections. Graft loss due to rejection occurred in 5/34 transplants (15%). Infections occurred in 68% of recipients overall and were no more frequent in patients receiving rejection therapy. Due to the high initial response rate, therapy with steroids is appropriate for first rejection episodes. Salvage therapy is often effective in reversing steroid resistant rejections and should be used early in patients with resistant or recurrent rejection. Graft loss to rejection continues to occur in a significant percentage of cases and retransplantation should be considered early if the response to salvage therapy is poor.