Advances in diagnosis, prevention, and management of hepatic allograft rejection

Russell H. Wiesner

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

Despite recent improvements in immunosuppressive therapy, hepatic allograft rejection remains a major cause of morbidity and late graft loss in patients undergoing liver transplantation. Although some biochemical tests suggest hepatic allograft damage, the gold standard for defining rejection remains based on morphologic findings. Acute cellular rejection usually occurs within the first 3 weeks posttransplantation and the incidence varies between 40% and 70%. Ductopenic rejection occurs in 5-10% of patients undergoing initial liver transplantation and usually occurs between 6 weeks and 6 months after the procedure. Induction and maintenance of immunosuppression with triple-drug therapy (cyclosporine, prednisone, and azathioprine) and other combinations that include antilymphocyte preparations have led to an overall decrease in the incidence of both cellular and ductopenic rejection. In addition, the availability of FK506 as a rescue therapy has saved grafts in some patients experiencing chronic (ductopenic) rejection. Overall, the correlation between the degree of biochemical liver dysfunction and the presence and severity of histologic rejection remains poor. Histologic severity of rejection, however, suggests which patients will require more immunosuppressive therapy and which patients may need antilymphocyte therapy to control the rejection episode. Some rejection episodes remain resistant to all known therapy and eventually lead to graft loss. New immunosuppressive agents and regimens are needed to improve graft and patient survival, decrease the incidence of cellular and ductopenic rejection, minimize drug-related side effects and complications, and reduce the high cost of immunosuppressive therapy.

Original languageEnglish (US)
Pages (from-to)2174-2185
Number of pages12
JournalClinical Chemistry
Volume40
Issue number11 II
StatePublished - 1994

Fingerprint

Immunosuppressive Agents
Grafts
Allografts
Liver
Transplantation (surgical)
Transplants
Drug therapy
Liver Transplantation
Incidence
Azathioprine
Tacrolimus
Therapeutics
Prednisone
Cyclosporine
Availability
Graft Survival
Drug-Related Side Effects and Adverse Reactions
Immunosuppression
Liver Diseases
Maintenance

ASJC Scopus subject areas

  • Clinical Biochemistry

Cite this

Advances in diagnosis, prevention, and management of hepatic allograft rejection. / Wiesner, Russell H.

In: Clinical Chemistry, Vol. 40, No. 11 II, 1994, p. 2174-2185.

Research output: Contribution to journalArticle

Wiesner, Russell H. / Advances in diagnosis, prevention, and management of hepatic allograft rejection. In: Clinical Chemistry. 1994 ; Vol. 40, No. 11 II. pp. 2174-2185.
@article{1fa99c7b0a0a40a79b9bfc35bf120975,
title = "Advances in diagnosis, prevention, and management of hepatic allograft rejection",
abstract = "Despite recent improvements in immunosuppressive therapy, hepatic allograft rejection remains a major cause of morbidity and late graft loss in patients undergoing liver transplantation. Although some biochemical tests suggest hepatic allograft damage, the gold standard for defining rejection remains based on morphologic findings. Acute cellular rejection usually occurs within the first 3 weeks posttransplantation and the incidence varies between 40{\%} and 70{\%}. Ductopenic rejection occurs in 5-10{\%} of patients undergoing initial liver transplantation and usually occurs between 6 weeks and 6 months after the procedure. Induction and maintenance of immunosuppression with triple-drug therapy (cyclosporine, prednisone, and azathioprine) and other combinations that include antilymphocyte preparations have led to an overall decrease in the incidence of both cellular and ductopenic rejection. In addition, the availability of FK506 as a rescue therapy has saved grafts in some patients experiencing chronic (ductopenic) rejection. Overall, the correlation between the degree of biochemical liver dysfunction and the presence and severity of histologic rejection remains poor. Histologic severity of rejection, however, suggests which patients will require more immunosuppressive therapy and which patients may need antilymphocyte therapy to control the rejection episode. Some rejection episodes remain resistant to all known therapy and eventually lead to graft loss. New immunosuppressive agents and regimens are needed to improve graft and patient survival, decrease the incidence of cellular and ductopenic rejection, minimize drug-related side effects and complications, and reduce the high cost of immunosuppressive therapy.",
author = "Wiesner, {Russell H.}",
year = "1994",
language = "English (US)",
volume = "40",
pages = "2174--2185",
journal = "Clinical Chemistry",
issn = "0009-9147",
publisher = "American Association for Clinical Chemistry Inc.",
number = "11 II",

}

TY - JOUR

T1 - Advances in diagnosis, prevention, and management of hepatic allograft rejection

AU - Wiesner, Russell H.

PY - 1994

Y1 - 1994

N2 - Despite recent improvements in immunosuppressive therapy, hepatic allograft rejection remains a major cause of morbidity and late graft loss in patients undergoing liver transplantation. Although some biochemical tests suggest hepatic allograft damage, the gold standard for defining rejection remains based on morphologic findings. Acute cellular rejection usually occurs within the first 3 weeks posttransplantation and the incidence varies between 40% and 70%. Ductopenic rejection occurs in 5-10% of patients undergoing initial liver transplantation and usually occurs between 6 weeks and 6 months after the procedure. Induction and maintenance of immunosuppression with triple-drug therapy (cyclosporine, prednisone, and azathioprine) and other combinations that include antilymphocyte preparations have led to an overall decrease in the incidence of both cellular and ductopenic rejection. In addition, the availability of FK506 as a rescue therapy has saved grafts in some patients experiencing chronic (ductopenic) rejection. Overall, the correlation between the degree of biochemical liver dysfunction and the presence and severity of histologic rejection remains poor. Histologic severity of rejection, however, suggests which patients will require more immunosuppressive therapy and which patients may need antilymphocyte therapy to control the rejection episode. Some rejection episodes remain resistant to all known therapy and eventually lead to graft loss. New immunosuppressive agents and regimens are needed to improve graft and patient survival, decrease the incidence of cellular and ductopenic rejection, minimize drug-related side effects and complications, and reduce the high cost of immunosuppressive therapy.

AB - Despite recent improvements in immunosuppressive therapy, hepatic allograft rejection remains a major cause of morbidity and late graft loss in patients undergoing liver transplantation. Although some biochemical tests suggest hepatic allograft damage, the gold standard for defining rejection remains based on morphologic findings. Acute cellular rejection usually occurs within the first 3 weeks posttransplantation and the incidence varies between 40% and 70%. Ductopenic rejection occurs in 5-10% of patients undergoing initial liver transplantation and usually occurs between 6 weeks and 6 months after the procedure. Induction and maintenance of immunosuppression with triple-drug therapy (cyclosporine, prednisone, and azathioprine) and other combinations that include antilymphocyte preparations have led to an overall decrease in the incidence of both cellular and ductopenic rejection. In addition, the availability of FK506 as a rescue therapy has saved grafts in some patients experiencing chronic (ductopenic) rejection. Overall, the correlation between the degree of biochemical liver dysfunction and the presence and severity of histologic rejection remains poor. Histologic severity of rejection, however, suggests which patients will require more immunosuppressive therapy and which patients may need antilymphocyte therapy to control the rejection episode. Some rejection episodes remain resistant to all known therapy and eventually lead to graft loss. New immunosuppressive agents and regimens are needed to improve graft and patient survival, decrease the incidence of cellular and ductopenic rejection, minimize drug-related side effects and complications, and reduce the high cost of immunosuppressive therapy.

UR - http://www.scopus.com/inward/record.url?scp=0028116205&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0028116205&partnerID=8YFLogxK

M3 - Article

VL - 40

SP - 2174

EP - 2185

JO - Clinical Chemistry

JF - Clinical Chemistry

SN - 0009-9147

IS - 11 II

ER -