From the Guidelines
Liver rejection is a serious complication that can occur in up to 10% of liver transplant recipients, typically within the first 3 months following transplantation, and is often associated with low CNI levels and noncompliance 1. The clinical features of liver rejection include fever, jaundice, and abdominal pain, which may suggest advanced rejection. Laboratory findings typically show hepatocellular abnormalities of serum liver function tests, but can also be seen with cholestatic abnormalities of serum liver function tests. Some key points to consider in liver rejection include:
- Acute rejection is most common within the first 3 months following liver transplantation, but can occur at any time 1.
- Chronic rejection resulting in fibrosis and disappearance of bile ducts may develop, resulting in severe biliary obstruction and jaundice, frequently associated with renal dysfunction 1.
- Treatment of rejection depends on severity, but may involve increasing CNI levels or the addition of sirolimus, and retransplantation should be considered if significant allograft synthetic dysfunction or portal hypertensive complications exist 1. It is essential to monitor liver function tests regularly to detect rejection episodes early, as untreated rejection can lead to graft failure, necessitating re-transplantation. In terms of management, the primary care doctor should be aware of the signs and symptoms of rejection and refer the patient back to the transplant center for urgent evaluation and treatment if suspected 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Features of Liver Rejection
- Liver rejection can be categorized into acute and chronic rejection, with chronic rejection causing damage to intrahepatic vessels and bile ducts, potentially leading to graft failure 2.
- Acute rejection generally occurs within 21 days of transplant and can be treated with steroids, with most patients responding well to antirejection therapy 3.
- Chronic rejection, on the other hand, may improve with escalation of immunosuppression or result in irreversible loss of graft function, leading to retransplantation or death 4.
- The incidence of acute and chronic rejection has declined in recent years due to improved immunosuppressive regimens 4.
Diagnosis of Liver Rejection
- Liver biopsy is currently the definitive method for diagnosing chronic rejection, but research is ongoing to identify non-invasive biomarkers for predicting patients at risk of rejection 2, 5.
- Biomarkers such as blood genomic assays, serum levels of cytokines, and donor-specific antibodies have shown promising results in predicting rejection pre- and post-transplant 5.
- Elevated liver transaminase levels can also be an indicator of liver rejection, but can also be caused by other factors such as nonalcoholic fatty liver disease, alcoholic liver disease, and viral hepatitis 6.
Management of Liver Rejection
- Antirejection therapy, including steroids and immunosuppressive agents, is effective in treating acute rejection, but may not be effective in chronic rejection 3, 4.
- A tailored management of the immunosuppression regimen is essential for preventing irreversible liver damage and minimizing the risk of rejection 2.
- Retransplantation may be necessary in cases of irreversible graft failure due to chronic rejection 2, 3.