Single centre experience of chronic rejection in liver transplantation

Objective: To review the Australian National Liver Transplantation Unit’s (ANLTU) experience with chronic rejection (CR) in liver transplantation (LTx) in order to establish a better management strategy. Materials and Methods: Clinical records and prospective data on the ANLTU database were reviewed. Statistical analysis was performed on microcomputer. Results: Between January 1986 and June 1997, 17 patients (6.4%) (9 male, 8 female) were diagnosed with CR at a median 0.83 years (0.21–6.33 years) after LTx. Prior to the diagnosis of CR, all had a background of increasingly cholestatic liver function tests. The total number of prior acute rejection episodes was 42 (mean 2.5, range 1–5) with 18 episodes (42%) being steroid resistant. Other co-morbid factors included: cytomegalovirus infection 10 (58%); low levels of immunosuppression 7 (41%); and biliary complications 6 (35%). Mortality was high at 14 (82%). Conclusions: The outcome is poor in adults with CR, with or without re-Tx. Efforts should be made to avoid septic complications that require lowering the dosage of immunosuppression. Early diagnosis and prompt treatment of acute rejection are recommended. In cases of early CR, conversion to FK506 regimen is worthwhile.