IS ACUTE REJECTION DELETERIOUS TO LONG-TERM LIVER ALLOGRAFT FUNCTION

Background/Aims: The decreasing incidence of chronic rejection after l iver transplantation emphasizes the need for an alternative end-point to assess the long-term consequences of acute rejection. The purpose o f this study was to determine the effects of resolved episodes of acut e rejection on late liver allograft function. Methods: Parameters of h epatic function (liver biochemistry, indocyanine green and sulfobromop hthalein clearances, histology) were analyzed in 170 consecutive adult recipients, who were followed prospectively on the basis of repeat an nual work-up. Mean follow-up was 3.7+/-0.2 years. Results: The rates o f acute and chronic rejection were 51% and 4.1%, respectively. At the last follow-up, there was no significant difference in graft function between patients with a single episode of acute rejection (n=56) and t hose without rejection (n=84). Among patients treated for a single epi sode of acute rejection, late hepatic function was not influenced by t he severity of acute rejection and the response to corticosteroids, In contrast, patients with recurrent acute rejection (n=30) had signific ant impairment of liver function tests (aspartate aminotransferase, p< 0.05; alanine aminotransferase, p<0.01; alkaline phosphatase, p<0.01; gamma-glutamyl transpeptidase, p<0.001), lower dye clearances (indocya nine green, p<0.01; sulfohromophthalein, p<0.01) and more severe histo logic damage (p<0.001). Conclusions: Single episodes of acute rejectio n do not impair the long-term hepatic function, whereas recurrent epis odes leave sequellar damage to the liver allograft. These results prov ide a rationale for converting patients with rejection to a heavier im munosuppressive regimen, while leaving nearly half the recipients on a lifelong light immunosuppressive regimen.