shared:gi-liver:rejection
Table of Contents
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
shared/gi-liver/rejection.txt · Last modified: 2020/12/10 11:59 by 127.0.0.1