Rejection in Liver Allograft Recipients: Clinical Characterization and Management

A retrospective study of 34 liver transplants in 31 recipients receiving cyclosporin A was conducted to assess the clinical features of rejection and the response to therapy. Thirty-eight rejection episodes were identified and treated in 34 transplants. Graft dysfunction was detected by biochemical testing, liver biopsy and radiographic studies. Rejection therapy was required in 24 of 34 transplants (71%). High-dose steroid therapy (3 x) successfully reversed 19/24 (79%) first-rejection episodes and 5/14 (36%) recurrent rejections (p>0.01) Salvage therapy (ALG) reversed 4/5 first and 5/8 recurrent rejections. Graft loss due to rejection occurred in 5/34 transplants (15%). 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 rejection and should also be used in recurrent rejection. Graft loss due to rejection continues to occur in a significant percentage of cases, and retransplantation should be considered early. Infections occurred in 68% of recipients and were not related to the antirejection treatment received. © 1987 Springer-Verlag.