© 2002 SAGE Publications
Chronic Rejection after Human Liver Transplantation
Survival figures after liver transplantation (OLT) have markedly improved with 1-year and 5-year patient survival rates approaching 90% and 80%, respectively. With increased short-term survival rates, chronic rejection (CR) has emerged as a major factor of morbidity and mortality after OLT. CR is characterized by the histological findings of ductopenia and decreased number of hepatic arteries in portal tracts in the presence of obliterative arteriopathy. However, in contrast to acute rejection, the incidence of CR is currently decreasing to 3% to 4%. The greatest risk factors for CR were acute or recurrent rejection episodes and retransplantation due to CRs. Other factors were underlying liver disease (autoimmune hepatitis, primary sclerosing cholangitis), CMV infection, and low levels of immunosuppression. Reasons for the decline of CR in clinical transplantations are unknown but may relate to improved immunosuppression. Outcome of CR after liver transplantation is poor and leads to graft failure more than 50% of the time. Treatments with tacrolimus and mycophenolate mofetil have shown to reverse CR, particularly when diagnosed in early histological stages.
Key Words: chronic rejection liver transplantation risk factors outcome