• Enoka Gonsalkorala
  • Daphne Hotho
  • Kosh Agarwal


The aims of this chapter are to provide an overview of the processes involved in immunological rejection after liver transplantation, outline immunosuppression strategies post liver transplantation, review the pharmacology of immunosuppressive agents and provide an overview for treatment of liver graft rejection.

Immunological Rejection

Liver transplantation has a lower incidence of rejection compared to other organs and does not require HLA matching of donor and recipient prior to transplantation. However, a substantial number of recipients still develop graft rejection. Table 32.1 is a summary of patterns of rejection seen in liver transplant recipients.
Table 32.1

Patterns of liver transplant rejection











Pre-sensitization to donor antigen

Endothelial injury, fibrin deposition

Urgent retransplantation


Acute cellular rejection

0–90 days


Inflammation induced by T cell...


Rejection Calcineurin inhibitors Steroids Antimetabolites Polyclonal antibodies Induction therapy 


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Enoka Gonsalkorala
    • 1
  • Daphne Hotho
    • 1
  • Kosh Agarwal
    • 1
  1. 1.Institute of Liver StudiesKings College HospitalLondonUK

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