Skip to main content
SpringerLink
Log in

Acute and Chronic Rejection of the Liver Allograft

  • Chapter
Liver Immunology

  • 1806 Accesses

Abstract

For the great majority of liver allograft recipients, immunosuppression is required life-long to prevent rejection. Spontaneous tolerance does develop in a small number of recipients. Although major advances have occurred in the numbers and modes of action of immunosuppressive agents available for clinical use, the modes of action of these agents is relatively wide and nonspecific: thus, the need to prevent rejection must be balanced against the risks of immunosuppression, which may be general (such as the increased risk of infection and some malignancies) or drug specific, such as the renal failure associated with the calcineurin inhibitors. Despite advances in care, death associated with rejection remains a concern (Fig. 1).

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 199.00
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Futagawa Y, Terasaki PI. An analysis of the OPTN/UNOS liver transplant registry. Clin Transplant 2004; 315–329.

    Google Scholar 

  2. Navarro V, Herrine S, Katopes C, Colombe B, Spain CV. The effect of HLA class I (A and B) and class II (DR) compatibility on liver transplantation outcomes: an analysis of the OPTN database. Liver Transplant 2006; 12:652–658.

    Article  Google Scholar 

  3. Egawa H, Oike F, Buhler L, et al. Impact of recipient age on outcome of ABO-incompatible living-donor liver transplantation. Transplantation 2004; 77:403–411.

    Article  PubMed  Google Scholar 

  4. Neuberger J, Adams DH. What is the significance of acute liver allograft rejection? J Hepatol 1998; 29:143–150.

    Article  PubMed  CAS  Google Scholar 

  5. Dousset B, Conti F, Cherruau B, et al. Is acute rejection deleterious to long-term liver allograft function? J Hepatol 1998; 29:660–668.

    Article  PubMed  CAS  Google Scholar 

  6. Calne RY. WOFIE hypothesis: some thoughts on an approach toward allograft tolerance. Transplant Proc 1996; 28:1152.

    PubMed  CAS  Google Scholar 

  7. Yoshizawa A, Sakamoto S, Ogawa K, et al. New protocol of immunosuppression for liver transplantation across ABO barrier: the use of rituximab, hepatic arterial infusion and preservation of spleen. Transplant Proc 2005; 37:1718–1719.

    Article  PubMed  CAS  Google Scholar 

  8. Haga H, Egawa H, Fujimoto Y, et al. Acute humoral rejection and C4d immunostaining in ABO-blood type-incompatible liver transplantation. Liver Transplant 2006; 12:457–464.

    Article  Google Scholar 

  9. Abraham SC, Furth EE. Receiver operating characteristic analysis of serum chemical parameters as tests of liver transplant rejection and correlation with histology. Transplantation 1995; 59:740–746.

    Article  PubMed  CAS  Google Scholar 

  10. Barnes EJ, Abdel-Rehim MM, Goulis Y, et al. Applications and limitations of blood eosinophilia for the diagnosis of acute cellular rejection in liver transplantation. Am J Transplant 2003; 3:432–438.

    Article  PubMed  Google Scholar 

  11. Duclos-Vallee JC, Johanet C, Bach JF, Yamamoto AM. Autoantibodies associated with acute rejection after liver transplantation for type-2 autoimmune hepatitis. J Hepatol 2000; 33:163–166.

    Article  PubMed  CAS  Google Scholar 

  12. Ge X, Ericzon BG, Nowak G, Horstrom H, Broome U, Sumitran-Holgersson S. Are preformed antibodies to biliary epithelial cells of clinical importance in liver transplantation? Liver Transplant 2003; 9:1191–1198.

    Article  Google Scholar 

  13. Hartono C, Dadhania D, Suthanthiran M. Non-invasive diagnosis of acute rejection of solid organ transplants. Front Biosci 2004; 9:45–53.

    Article  Google Scholar 

  14. Bolognesi M, Sacerdoti D, Mescoli C, et al. Acute liver rejection: accuracy and predictive values of Doppler US measurements—initial experience. Radiology 2005; 235:651–658.

    Article  PubMed  Google Scholar 

  15. International Working Party. Terminology for hepatic allograft rejection. Hepatology 1995; 22:648–654.

    Google Scholar 

  16. Hassoun Z, Shah V, Lohse CM, Pankratz VS, Petrovic LM. Centrilobular necrosis after orthotopic liver transplant association with acute cellular rejection and outcome. Liver Transplantation 2004; 10:480–487.

    Article  PubMed  Google Scholar 

  17. Demetris AJ, Ruppert K, Dvorchik I, et al. Real-time monitoring of acute liver-allograft rejection using the Banff schema. Transplant 2002; 74:1290–1296.

    Article  CAS  Google Scholar 

  18. Horoldt B, Burattin M, Gunson B, et al. Does the Banff rejection activity index predict outcome in patients with early acute cellular rejection following liver transplantation? Liver Transplant 2006; 12:1144–1151.

    Article  Google Scholar 

  19. Wiesner RH, Demetris AJ, Belle SH, et al. Acute hepatic allograft rejection: incidence, risk factors and impact on outcome. Hepatology 1998; 28:638–645.

    Article  PubMed  CAS  Google Scholar 

  20. O’Grady J, Burroughs A, Hardy P, Elbourne D, Truesdale A; UK and Republic of Ireland Liver Transplant Study Group. Tacrolimus versus microemulsified ciclosporin in liver transplantation: the TMC randomised controlled trial. Lancet 2002; 360:1119–1125.

    Article  PubMed  CAS  Google Scholar 

  21. Levy G, Villamil F, Samuel D, et al. LIS2T Study group. Results of LIS2T, a mutlicentre, randomised study comparing cyclosporine microemulsion with C2 monitoring and tacrolimus with C0 monitoring in de novo liver transplantation. Transplantation 2004; 77:1632–1638.

    Article  PubMed  CAS  Google Scholar 

  22. Slifkin M, Ruthazer R, Freeman R, et al. Impact of cytomegalovirus prophylaxis in rejection following orthotopic liver transplantation. Liver Transplant 2005; 11:1597–1602.

    Article  Google Scholar 

  23. Warle MC, Metselaar HJ, Hop WC, Tilanus HW. Cytokine gene polymorphisms and acute liver graft rejection: a meta-analysis. Liver Transplant 2005; 11:19–26.

    Article  Google Scholar 

  24. De Reuver P, Pravica V, Hop W, Hutchinson IV, Tilanus HW, Kwekkeboom J. Recipient CTLA-4 +49G/G genotype is associated with reduced incidence of acute rejection after liver transplantation. Am J Transplant 2003; 3:1587–1594.

    Article  PubMed  Google Scholar 

  25. Schroppel B, Fischereder M, Lin M, et al. Analysis of gene polymorphisms in the regulatory region of MCP-1, RANTES, and CCR5 in liver transplant recipients. J Clin Immunol 2002; 22:381–385.

    Article  PubMed  Google Scholar 

  26. Orr DW, Portmann BC, Knisely AS, et al. Anti-interleukin-2 receptor antibodies and mycophenolate mofetil for treatment of steroid-resistant rejection in adult liver transplantation. Transplant Proc 2005; 37:4373–4379.

    Article  PubMed  CAS  Google Scholar 

  27. Stephenne X, Najimi M, Janssen P, Reding R, de Ville de Goyet J, Sokal EM. Liver allograft radiotherapy to treat rejection in children: efficacy in orthotopic liver transplantation and long-term safety. Liver Int 2005; 25:1108–1113.

    Article  PubMed  Google Scholar 

  28. Anand A, Hubscher SG, Gunson BK, McMaster P, Neuberger J. Timing, significance and prognosis of late acute liver allograft rejection. Transplant 1995; 60:1098–1103.

    Article  CAS  Google Scholar 

  29. Schmeding M, Dankof A, Krenn V, et al. C4d in acute rejection after liver transplantation—a valuable tool in differential diagnosis to hepatitis C recurrence. Am J Transplant 2006; 6:523–530.

    Article  PubMed  CAS  Google Scholar 

  30. Hubscher SG, Buckels JA, Elias E, McMaster P, Neuberger J. Vanishing bile-duct syndrome following liver transplantation—is it reversible? Transplant 1991; 51:1004–1010.

    Article  CAS  Google Scholar 

  31. Dubel L. Farges O, Johanet C, Sebagh M, Bismuth H. High incidence of anti-tissue antibodies in patients experiencing chronic liver allograft rejection. Transplant 1998; 65:1072–1075.

    Article  CAS  Google Scholar 

  32. Demetris AJ, International Panel. Update of the International Banff Schema for liver allograft rejection: recommendations for the histopathologic staging and reporting of chronic rejection. Hepatology 2000; 31:792–799.

    Article  PubMed  CAS  Google Scholar 

  33. Freese DK, Snover DC, Sharp HL, Gross CR, Savick SK, Payne WD. Chronic rejection after liver transplantation: a study of clinical, histopathologic and immunological features. Hepatology 1991; 13:882–891.

    Article  PubMed  CAS  Google Scholar 

  34. Candinas D, Gunson BK, Nightingale PG, Hubscher SG, McMaster P, Neuberger JM. Sex-mismatch as a risk factor for chronic rejection of liver allografts. Lancet 1995; 346:1117–1121.

    Article  PubMed  CAS  Google Scholar 

  35. Evans PC, Soin A, Wreghitt TG, Taylor CJ, Wight DG, Alexander GJ. An association between cytomegalovirus infection and chronic rejection after liver transplantation. Transplantation 2000; 69:30–35.

    Article  PubMed  CAS  Google Scholar 

  36. Neumann UP, Guckelberger O, Langrehr JM, et al. Impact of human leukocyte antigen matching in liver transplantation. Transplantation 2003; 75:132–137.

    Article  PubMed  CAS  Google Scholar 

  37. Guilbeau JM. Delayed wound healing with sirolimus after liver transplant. Ann Pharmacother 2002; 36:453

    Article  Google Scholar 

  38. Neff GW, Montalbano M, Tzakis A. Ten years of sirolimus therapy in orthotopic liver transplant recipients. Transplant Proc 2003; 35:209S–216S.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. The Liver Unit, Queen Elizabeth Hospital, Birmingham, UK

    James Neuberger DM, FRCP

Authors
  1. James Neuberger DM, FRCP
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Division of Rheumatology, Allergy and Clinical Immunology, University of California at Davis School of Medicine, Davis, CA

    M. Eric Gershwin MD, FACP

  2. Departments of Medicine and Surgery Baylor Liver Health, Baylor College of Medicine, Houston, TX

    John M. Vierling MD, FACP

  3. Department of Gastroenterology, Hepatology, and Endocrinology, Medical School of Hannover, Hannover, Germany

    Michael P. Manns MD

Rights and permissions

Reprints and permissions

Copyright information

© 2007 Humana Press Inc., Totowa, NJ

About this chapter

Cite this chapter

Neuberger, J. (2007). Acute and Chronic Rejection of the Liver Allograft. In: Gershwin, M.E., Vierling, J.M., Manns, M.P. (eds) Liver Immunology. Humana Press. https://doi.org/10.1007/978-1-59745-518-3_33

Download citation

  • DOI: https://doi.org/10.1007/978-1-59745-518-3_33

  • Publisher Name: Humana Press

  • Print ISBN: 978-1-58829-818-8

  • Online ISBN: 978-1-59745-518-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation