| Abstrakt: |
Despite attempts to optimize routine maintenance immunosuppression, rejection is still one of the most frequent causes of graft dysfunction seen after liver transplantation. Using cyclosporine and prednisolone for baseline immunosuppression, 104 patients who received liver transplantation at Baylor University Medical Center were studied. Liver biopsies were performed weekly according to protocol, and on clinical indication to monitor graft dysfunction and to follow response to rejection therapy. Primary rejection therapy consisted of high‐dose steroids. OKT*3 was given as rescue therapy. Azathioprine was started when a rejection was diagnosed. After approximately 1100 liver biopsies, only 7 complications were recorded. In one patient surgery was necessary. There was no mortality. On this immunosuppressive protocol, 39% of patients never experienced acute rejection. Of the 61% who did, two‐thirds had one, and one‐third of the patients had 2 or more acute rejections. Ninety‐five percent of the first rejections occurred within the first 3 weeks of transplantation. There were 18 deaths, 4 of which resulted from complications of acute and chronic rejection. In 6 patients, the diagnosis of chronic rejection was made. We conclude that rejection is still a major cause of disability after liver transplantation but that present immunosuppressive therapy is effective in control. |
