Acute allograft rejection in liver transplant recipients: Incidence, risk factors, treatment success, and impact on graft failure

OBJECTIVE: This study was performed to identify risk factors for acute cellular rejection after liver transplantation (LT). METHODS: Consecutive LT recipients who underwent surgery in our institution from 2002 to 2015 were retrospectively evaluated. RESULTS: In total, 176 patients were eligible for statistical analysis. During a mean observation period of 61.1 ± 36.3 months, 43 episodes of acute rejection were evident. Of these, 34 (79.0%) were responsive to methylprednisolone, 3 (7.0%) were treated by adjusting the dosage of immunosuppressive agents, and 6 (14.0%) were methylprednisolone-resistant and treated using anti-thymocyte globulin. Biliary complications (odds ratio [OR] = 4.89, 95% confidence interval [CI] = 2.00–11.98); donor-negative, recipient-positive CMV mismatch (OR = 9.88, 95% CI = 1.18–82.36); sex mismatch (OR = 3.16, 95% CI = 1.31–8.10); and sex mismatch with a female donor (OR = 3.00, 95% CI = 1.10–7.58) were identified as significant risk factors for acute graft rejection after LT. CONCLUSION: In patients who develop acute cellular rejection after LT, biliary complications should be evaluated as a potential cause. Most acute rejections after LT respond to bolus corticosteroid therapy.