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Graft Dysfunction

Liver Unit Queen Elizabeth Hospital, geoffhay{at}email.msn.com

The causes of graft dysfunction are classified either according to the time posttransplantation or to the etiology of graft dysfunction. Primary dysfunction can be due to massive hemorrhagic necrosis, ischemia/reperfusion injury, or hepatic artery thrombosis. Acute cellular rejection (ACR) occurs in 20% to 80% of grafts, usually 5 to 30 days posttransplant. ACR generally is asymptomatic. Chronic ductopenic rejection is defined histopathologically by obliterative vasculopathy and bile duct loss. CMV and EBV infections also diminish graft function. Malignancies occur in solid organ transplant recipients with a frequency 10-1000 times that of the normal population. Skin cancer and lymphoma are the most common types. Posttransplant lymphoproliferative disorders (PTLD) are associated with EBV infection. There are three types of PTLD: polyclonal B-cell hyperplasia, polymorphic B-cell lymphoma, and monoclonal polymorphic B-cell lymphoma. Graft ischemia is due to hepatic artery thrombosis (HAT), hepatic artery stenosis, and portal vein thrombosis. Biliary complications are the most frequent late complications of liver transplantation, with an incidence of 15% to 20%.

Key Words: liver transplantation • Banff criteria • cytomegalovirus • Epstein-Barr virus

References

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• 4. Demetris A, Adams D, Bellamy C, et al. Update of the International Banff Schema for Liver Allograft Rejection: working recommendations for the histopathologic staging and reporting of chronic rejection. An International Panel. Hepatology 2000;31:792-799.
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• 6. Heneghan MA, Portmann BC, Norris SM, Williams R, Paolo Muiesan P, Mohamed Rela M, et al. Graft dysfunction mimicking autoimmune hepatitis following liver transplantation in adults. Hepatology 2001;34:464-470.[Medline] [Order article via Infotrieve]

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This Article Abstract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Saved Citations Download to citation manager Reprints and Permissions Add to My Marked Citations Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Haydon, G. H. Search for Related Content Social Bookmarking                   What's this?