Overview
Chronic rejection is a long-term complication following organ transplantation, characterized by a gradual decline in graft function. In liver transplantation, this process can lead to graft failure and necessitate re-transplantation.Diagnosis
Diagnosis is typically made based on a combination of clinical signs, laboratory abnormalities, and graft biopsy findings 1.
Key indicators include progressive cholestasis, rising liver enzymes, and impaired synthetic function 1.
Liver biopsy is crucial for confirming chronic rejection and excluding other causes of graft dysfunction 1.Management
Management strategies are often directed at immunosuppression and may involve adjusting maintenance immunosuppressive agents 1.
Treatment may include increasing the dose of calcineurin inhibitors or switching to alternative agents 1.
Other approaches may involve adding or substituting antiproliferative agents 1.Key Recommendations
Management of chronic rejection often involves modification of immunosuppressive therapy 1. (Evidence: Expert opinion)
Liver biopsy is recommended to confirm the diagnosis and rule out other causes of graft dysfunction 1. (Evidence: Expert opinion)
Treatment strategies may include adjusting calcineurin inhibitor doses or switching to alternative immunosuppressive agents 1. (Evidence: Expert opinion)References
1 Parker A, Chaya BF, Rodriguez-Colon R, Hao Y, Kurian K, Trilles J et al.. Recipient Selection Criteria for Facial Transplantation: A Systematic Review. Annals of plastic surgery 2022. link