New diagnostic methods of acute rejection after living donor liver transplantation

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At Tokyo University Hospital, 63 living-related liver transplantation have been performed since January, 1996. There were 27 males and 36 females (Average age : 14.9 years, range : 8 months-62 years). The diagnoses were biliary atresia in 40, primary biliary cirrhosis in 8, liver cirrhosis in 7, Alagille syndrome in 2 and others in the remaining 5. FK506 and steroid were employed as main immunosuppressive drugs. Acute rejection was diagnosed by the elevation of T-Bil, GOT, GPT, ALP and G-GTP, which was confirmed histologically. 15 of 52 patients showed acute rejection, whereas the remaining 37 had no rejection. Histology showed cellular infiltration in the Gulissonian triad, destruction of the bile duct and endothelialitis. Furthermore, liver dysfunction with eosinophilia in the peripheral blood highly suggested the presence of acute rejection. Whereas alteartions of cytokines in the peripheral blood were not specific to the acute rejection.