Evolving concepts in the diagnosis, pathogenesis, and treatment of chronic hepatic allograft rejection

R. H. Wiesner, K. P. Batts, R. A F Krom

Research output: Contribution to journalArticle

75 Citations (Scopus)

Abstract

Chronic hepatic allograft rejection is characterized by the histological findings of ductopenia and a decreased number of hepatic arteries in portal tracts in the presence of foam cell (obliterative) arteriopathy. Recent studies have extended the histological spectrum of chronic rejection to include the presence of biliary epithelial atrophy or pyknosis involving the majority of small ducts present in the liver biopsy specimen. Overall, the incidence of chronic rejection in adults appears to be decreasing and is currently approximately 4%. However, the incidence of chronic rejection in pediatric liver transplant recipients has been more stable and ranges from 8% to 12% in most studies. Clinical risk factors associated with chronic rejection include: underlying liver disease, HLA donor-recipient matching, positive lymphocytotoxic cross-match, cytomegalovirus infection, recipient age, donor-recipient ethnic origin, male donor into female recipient, number of acute rejection episodes, histological severity of acute rejection episodes, low cyclosporine trough levels, and retransplantation for chronic rejection. Chronic rejection, once diagnosed, frequently leads to graft failure; however, a number of reports indicated 20% to 30% of the patients with this diagnosis may respond to additional immunosuppressive therapy or even resolve spontaneously receiving baseline immunosuppression. Newer immunosuppressive agents, such as tacrolimus and mycophenolate, may successfully reverse chronic rejection, particularly when it is diagnosed in its early histological stages.

Original languageEnglish (US)
Pages (from-to)388-400
Number of pages13
JournalLiver Transplantation and Surgery
Volume5
Issue number5
StatePublished - 1999

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Allografts
Tissue Donors
Immunosuppressive Agents
Liver
Foam Cells
Hepatic Artery
Incidence
Cytomegalovirus Infections
Tacrolimus
Immunosuppression
Cyclosporine
Atrophy
Liver Diseases
Therapeutics
Pediatrics
Transplants
Biopsy
Transplant Recipients

ASJC Scopus subject areas

  • Hepatology
  • Surgery

Cite this

Evolving concepts in the diagnosis, pathogenesis, and treatment of chronic hepatic allograft rejection. / Wiesner, R. H.; Batts, K. P.; Krom, R. A F.

In: Liver Transplantation and Surgery, Vol. 5, No. 5, 1999, p. 388-400.

Research output: Contribution to journalArticle

Wiesner, R. H. ; Batts, K. P. ; Krom, R. A F. / Evolving concepts in the diagnosis, pathogenesis, and treatment of chronic hepatic allograft rejection. In: Liver Transplantation and Surgery. 1999 ; Vol. 5, No. 5. pp. 388-400.
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