IMPORTANCE OF CONCOMITANT VIRAL-INFECTION DURING - LATE ACUTE LIVER ALLOGRAFT-REJECTION

We have determined accompanying events and reviewed the management and outcome of late acute cellular rejection episodes in 384 consecutive liver recipients. A significant proportion of patients experienced con comitant viral infection (group 1, n=15 [41%]), with CMV infection com prising the largest group and smaller contributions from other viruses (CMV, 30%; HSV, 5%; EBV, 3%; varicella zoster virus, 3%). Thirteen (3 5%) patients (group 2) developed late rejection associated with low ma intenance immunosuppression, and in a further 10 patients (group 3), n o accompanying factor could be identified. Refractory rejection was hi gher in late compared with early rejection episodes in our series (29% vs. 9.2%, P<0.05). Antiviral chemotherapy administered in rejection e pisodes with concomitant viral infection, either as sole treatment in cases with accompanying hepatitis or as adjunctive therapy to further supplemental immunosuppression in episodes of steroid-resistant reject ion, controlled the rejection process in all treated patients.