According to the time, pathology, pathophysiology of rejection, the rejection is differentiated as super acute rejection, acute rejection and chronic rejection.
The occurence of super acute rejection is usually because of the existence of specific antibody in recipient to the donor's antigen. It commonly happens in heterogenous transplantation, such as porcine organ to human. It rarely happens in allogeneic transplantation.
Acute rejection is the most common rejection after liver transplantation. Usually it happens in the first month after the operation. But, it can arise at any time after transplantation, only that the incidence is decreasing. When acute rejection, the patients usually complain of abdominal discomfortness, poor appetite, fever, etc. By lab examination, blood total bilirubin, transaminase could be found elevated. Liver fine needle biopsy should be performed to confirm the diagnosis and the degree of acuter rejection. If treated on time, the effect of treatment is usually satisfying, and acute rejection can be totally reversed, no sequelae would be left. Treatment protocols commonly used:
For acute rejection 1. steriods bolus therapy
2. modification the level of immunosuppression
3、changing of immunosuppressants, such as OKT3, ALG, ATG, etc.
Chronic rejecion
　　 The chronic rejection usually presents as the gradually deterioration of the allograft's function until it's failure months or years after the transplantation. In pathology, it presents as the damage and lose of biliary ductules and the damages of the secondary or tertiary branches of hepatic arteries. The mechanism of chronic rejection is not clearly understood now, and no determinant treatment methods is available. Some of the patients need retransplantation to rescue their lives.
severe coagulation dysfunction
repeated voluntary peritonitis
liver-kidney syndrome
severe sopor, refractory itch, severe metabolic osteopathia, repeated choliangitis
LAB FINGDINGS,
albumin<25g/l
PT 5s than normal
TBIL>50mg/l