Posttransplant B, non-A non-B, and cytomegalovirus hepatitis increase the risk of developing chronic rejection after liver transplantation.

Abstract

Chronic rejection is a serious complication of orthotopic liver transplantation (OLT) and is a major cause of late hepatic allograft failure. Risk factors leading to the development of chronic rejection have been identified. Two of these are lack of response to acute rejection therapy and allograft cytomegalovirus (CMV) infection.1–3 However, many patients develop chronic rejection without any identifiable risk factor. Furthermore, the intrinsic mechanism involved in the development of chronic rejection is not fully understood. In general, chronic rejection is a progressive disease but there are instances where it appears to reverse or stabilize over time.4,5 Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are major causes of end-stage liver disease. Both infections persist after OLT leading to recurrence of hepatitis in many patients. When the allograft is infected with either of these viruses, it may be difficult to distinguish histopathologically between hepatitis and rejection.6 We postulated that development of posttransplant hepatitis B or C may influence the development of chronic rejection after liver OLT.