Two types of allograft rejection are seen after liver transplantation. Cellular rejection, which is usually manifested by elevated aminotransferase levels, is most commonly seen six to 10 weeks after transplantation. The diagnosis is confirmed by liver biopsy, which reveals cellular invasion of small bile ducts and vascular endothelium. Most patients respond rapidly to increased immunosuppression with a bolus of corticosteroid or OKT3. Ductopenic rejection is a more indolent process that usually presents as progressive jaundice months to years after transplantation.
Liver biopsies reveal gradual disappearance of intrahepatic bile ducts.
Although in some cases patients have been salvaged with tacrolimus therapy, most patients require retransplantation. Infectious Complications Infections remain among the most serious complications encountered after liver transplantation. In the early postoperative period, patients are primarily at risk for fungal and nosocomial bacterial infections. Candidiasis and aspergillosis remain the most serious infections encountered after liver transplantation. They often occur in malnourished, critically ill patients and are frequently fatal.