shared:gi-liver:rejection

Table of Contents

Acute Cellular
Chronic Ductopenic
Humoral
Miscellaneous

Acute Cellular

Mechanism: T-cell mediated
Lab abnormalities: AST/ALT elevations, Alk Phos/bilirubin if severe
Dx:
- based on pathology not chronology with duct injury, mixed cellular infiltrate, endothelialitis
- each component scored out of 3 points to give RAI score (max 9)
Timeline: usually within 1st year
Tx: steroids and tacrolimus or mycophenolate

Chronic Ductopenic

Lab abnormalities: Alk Phos + Bili, LFT usually later
Pathology: portal dyads seen instead of triads due to affect on ducts
Presentation: pruritus, jaundice if severe
Tx: calcineurin inhibitors

Humoral

Mechanism: B-cell mediated
Epidemiology: Rare
Pathophysiology: high donor-specific antigen
Tx: Plasmapharesis

Miscellaneous

RAI: three components scored out of 3 each
Differential for LFT elevations in transplant population
- Rejection
- Bile duct injury/anastomotic strictures
- Infection: CMV, EBV causing PTLD, bacterial/fungal, HepE
- Recurrence of original disease
- Vascular: hepatic vein stricture, portal vein stricture
- de novo transplant hepatitis: probably form of rejection, presents as autoimmune hepatitis
Evaluation
- Abdominal US
- MRCP