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.
