Incidence, epidemiology and outcomes of acute allograft rejection following liver transplantation in Australia

Liver Transpl. 2024 Apr 23. doi: 10.1097/LVT.0000000000000375. Online ahead of print.


Background: Acute allograft rejection is a well-known complication of liver transplantation (LT). The incidence, epidemiology and outcomes of acute rejection have not been well-described in Australia.

Methods: We retrospectively studied consecutive adults who underwent deceased-donor LT at a single centre between 2010-2020. Donor and recipient data at time of LT and recipient outcomes were collected from a prospective LT database. Liver biopsy reports were reviewed and only a graft's first instance of biopsy-proven acute rejection was analysed.

Results: During the study period, 796 liver transplants were performed in 770 patients. Biopsy-proven rejection occurred in 34.9% of transplants. There were no significant changes in the incidence of rejection over time (linear trend p=0.11). The median time to first episode of rejection was 71 days post-LT: 2.2% hyperacute, 50.4% early (≤90 d) and 47.5% late rejection (>90 d). Independent risk factors for rejection were younger recipient age at transplant (aHR 0.98 per year increase, 95% CI 0.97-1.00, p=0.01), and ABO-incompatible grafts (aHR 2.55 vs. ABO-compatible, 95% CI 1.27-5.09, p<0.01) while simultaneous multiorgan transplants were protective (aHR 0.21 vs. LT only, 95% CI 0.08-0.58, p<0.01). Development of acute rejection (both early and late) was independently associated with significantly reduced graft (aHR 3.13, 95% CI 2.21-4.42, p<0.001) and patient survival (aHR 3.42, 95% CI 2.35-4.98, p<0.001).

Conclusion: In this 11-year Australian study, acute LT rejection occurred in 35%, with independent risk factors of younger recipient age and ABO-incompatible transplant while having a simultaneous multiorgan transplant was protective. Acute rejection was independently associated with reduced graft and patient survival after adjustment for other factors.