Abstract
In the United States, more than six thousand patients undergo liver transplantation (LT) annually with generally excellent outcomes reflected in patient survival o f 88% at one year and
80% at three years and graft survival o f 83% and 74%.1 Advances in
immunosuppression have made acute cellular rejection a negligible
threat to hepatic graft survival in compliant patients and generally
long-term threats to graft survival reflect recurrent disease rather
than rejection. Chronic rejection although relatively infrequent
in LT recipients remains an important cause o f graft loss and may
reflect noncompliance. However, other threats to graft viability have
been recognized as the practice o f liver transplant has evolved. Use
o f nonheart beating donors results in frequent non-anastomotic
stricturing and higher graft failure (relative risk 1.85) with the need
for retransplantation.2 Older donor grafts are a factor in more severe
recurrence o f HCV. Interferon therapy to treat H CV recurrence
has been implicated in profound graft dysfunction reminiscent
o f chronic rejection. W ith longer term follow-up recurrence o f
nonviral disease has become more obvious. Recurrent cholestatic
liver disease, most notably primary sclerosing cholangitis, can lead
to graft loss. As the significance of non-alcoholic fatty liver disease
as a cause o f decompensated cirrhosis and hepatocellular carcinoma
has become more fully appreciated, recurrent hepatic steatosis has
now entered into the differential o f graft dysfunction as has de novo
hepatic steatosis.