SELECTIVE TREATMENT OF EARLY ACUTE REJECTION AFTER LIVER-TRANSPLANTATION - EFFECTS ON LIVER, INFECTION-RATE, AND OUTCOME

To evaluate the results of selective treatment of biopsy-proven mild a cute rejection episodes, we retrospectively studied 1-week liver biops ies of 103 patients with a primary liver graft in relation to liver fu nction tests. The overall incidence of rejection was 35 %. In four pat ients the biopsy showed histological features consistent with rejectio n; in 27 patients it showed mild acute rejection (grade 1), and in 5 p atients it showed moderate acute rejection (grade 2). Study group 1 co nsisted of 19 untreated patients with grade 1 rejection and group 2 of 8 treated patients with grade 1 rejection. At 30 and 90 days, no diff erences in liver function tests were found. The infection rate, histol ogy after 1 year, and survival in the two groups did not differ. It ma y, therefore, be concluded that withholding treatment in histologicall y proven mild acute rejection is possible in selected patients based o n histological, biochemical, and clinical criteria. This may reflect t he functional diversity of morphologically similar lymphocytic infiltr ates observed in graft biopsies showing features of mild acute rejecti on.