How is acute graft rejection treated in liver transplant patients?

Updated: Dec 31, 2017
  • Author: Lemi Luu, MD, RDMS, FACEP, FAAEM; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
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Acute rejection occurs in 20-70% of cases, most often at 7-14 days post transplant, and results in graft dysfunction. Acute rejection is represented clinically as jaundice with laboratory evidence of abnormal liver function tests. Bilirubin and alkaline phosphatase levels rise initially, followed by elevations in the hepatocellular enzymes alanine aminotransferase (ALT) and aspartate aminotransferase (AST). Other symptoms may include fever, liver tenderness, and eosinophilia.

Acute rejection is most commonly treated with high-dose steroids (prednisolone 200 mg or methylprednisolone 1 g for 3 days) or a high-dose steroid bolus followed by a rapid taper over 5-7 days. These treatment regimens are effective in 65-80% of transplant recipients. Alternative therapies include antibody treatments such as monoclonal therapy with OKT3 or rabbit antithymocyte globulin.

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