Advances in Diagnosis, Prevention, and Management of Hepatic Allograft Rejection

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 proce-dure. Induction and maintenance of immunosuppression with triple-drug therapy (cyclosporine, prednisone, and azathioprine) and other combinations that include anti-lymphocyte preparations have led to an overall decreas