Background/Aims:The decreasing incidence of chronic rejection after liver transplantation emphasizes the need for an alternative end-point to assess the long-term consequences of acute rejection. The purpose of this study was to determine the effects of resolved episodes of acute rejection on late liver allograft function.Methods:Parameters of hepatic function (liver biochemistry, indocyanine green and sulfobromophthalcin clearances, histology) were analyzed in 170 consecutive adult recipients, who were followed prospectively on the basis of repeat annual work-up. Mean follow-up was 3.7 plusmn; 0.2 years.Results:The rates of acute and chronic rejection were 51percnt; and 4.1percnt;, respectively. At the last follow-up, there was no significant difference in graft function between patients with a single episode of acute rejection (n =56) and those without rejection (n= 84). Among patients treated for a single episode of acute rejection, late hepatic function was not influenced by the severity of acute rejection and the response to corticosteroids. In contrast, patients with recurrent acute rejection (n= 30) had significant impairment of liver function tests (aspartate amino-transferase,p 0.05; alanine aminotransferase,p 0.01; alkaline phosphatase,p 0.01; gamma;-glutamyl transpeptidase,p 0.001), lower dye clearances (indocyanine green,p 0.01; sulfobromophthalein,p 0.01) and more severe histologic damage (p 0.001).Conclusions:Single episodes of acute rejection do not impair the long-term hepatic function, whereas recurrent episodes leave sequellar damage to the liver allograft. These results provide a rationale for converting patients with rejection to a heavier immunosuppressive regimen, while leaving nearly half the recipients on a lifelong light immunosuppressive regimen.
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