Liver acute cellular rejection

Mion F, Cloix P, Boillot O, Gille D, Bouvier R, Paliard P, Berger F. Maladie veino-occlusive apres transplantation hepatique. Association d un rejet aigue cellulaire et de la toxicite de I azathioprine. [Veno-occlusive disease after liver transplantation. Association of acute cellular rejection and toxicity of azathioprine.] Gastroenterol Clin Biol 1993 17(ll) 863-7. 

Nagral A, Quaglia A, Sabin C, Dhillon A, Bearcroft C, Millar A, et al. Blood and graft eosinophils in acute cellular rejection of liver allografts. Transplant Proc 2001 33 2588-93. 

Chronic rejection is a major cause of late graft loss and is one of the most important problems that remains to be resolved. While chronic rejection simply may be a slow and indolent form of acute cellular rejection, the involvement of the humoral immune system and antibodies against the vascular endothelium appear to play a role. Persistent perivascular and interstitial inflammation is a common finding in kidney, liver, and heart transplantation. Owing to the complex interaction of multiple drugs and diseases over time, it is difficult to dehneate the true nature of chronic rejection. For example, cytomegalovirus is associated with the development of chronic rejection in both liver and heart transplant recipients. Unlike acute rejection, chronic rejection is not reversible. 

Acute cellular rejection is common, and usually occurs in the first month after transplantation. The majority of cases are steroid responsive. A liver biopsy is required to prove the diagnosis, and exclude other causes of graft dysfunction. Graft loss due to acute rejection is uncommon. 

The finding of mild to moderate liver function test abnormalities that normalized on dosage reduction or withdrawal of tacrohmus has suggested possible dose-related hepatotoxicity (66). In fiver transplant patients, fiver biopsy showed a centrilobular hepatocellular dropout with sinusoidal dilatation and congestion, and no features of cellular rejection or acute hepatitis. 

Dankof A, Schmeding M, Morawietz L, et al. Portal capillary C4d deposits and increased infiltration by macrophages indicate humorally mediated mechanisms in acute cellular liver allograft rejection. Virchows Arch. 2005 447 87-93. 

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