Liver Graft Rejection

Graft RejectionAssociated Pathology of Hepatic Transplant Rejection

Hepatic pathology associated with transplantation includes the following clinical features:

Preservation injury:

Appears early, usually few weeks after transplantation.

Humoral Rejection:

Rare, appears within hours after the transplantation is done. Leads to haemorrhagic premature death of cells (necrosis)

Acute Rejection:

most common form of rejection. Usually results due to immmunosupresssion.

Chronic Rejection :

Acute Rejection leads to chronic rejection, Results in cholestasis ( bile can not flow from liver to duodenum.

Other Complications of Liver Graft Rejection

Other complications of liver graft rejection include the following:

  • Bile duct stricture: It occurs alone or in combination with portal vein thrombosis. It occurs mostly in children. It leads to death of the tissue due to blockage of blood supply (infarction)
  • Common infection
  • Drug induced injury:Often results due to immunosuppressants
  • Recurrent diseases such as neoplastic ( new cell growth) diseases and chronic hepatitis
  • Hepatitis
  • Common biliary cirrhosis

Diagnosis of Liver Graft Rejection

Diagnosis is generally carried out using a combination of methods which include clinical, radiological, laboratory, and histopathological tools.

The following methods are generally followed for the diagnosis of liver graft rejection:

Percutaneous liver biopsies:

Generally obtain to study the deteriorated liver function

Protocol Biopsies:

These are obtained according to planned schedules irrespective of liver chemistry

Fine needle Aspiration Biopsy:

Fine needle Aspiration Biopsies is carried out by an adequately experienced person.

Time Zero biopsies :

Time zero Biopsies are obtained directly at transplantation immediately after revascularization.

Differential Diagnosis

Diagnosis generally done by selection the any of the following 2 differential diagnoses to compare with Liver Transplant.

  • Cholestasis
  • Acute Hepatitis
  • Chronic hepatitis liver

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