How does chronic graft rejection manifest 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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Chronic graft rejection, manifested by gradual obliteration of small bile ducts and microvascular changes, occurs in about 5% of patients. Diagnosis is made by means of liver biopsy. Chronic graft rejection is the major cause of late graft failure. The primary finding is persistently elevated serum alkaline phosphatase and bilirubin levels, suggesting a cholestatic liver injury pattern. This may manifest as jaundice and/or pruritus. Loss of liver synthetic function may not be evident until very late in the course.

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