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World J Gastroenterol. Dec 7, 2021; 27(45): 7771-7783
Published online Dec 7, 2021. doi: 10.3748/wjg.v27.i45.7771
Chronic rejection after liver transplantation: Opening the Pandora’s box
Roberta Angelico, Bruno Sensi, Tommaso M Manzia, Giuseppe Tisone, Giuseppe Grassi, Alessandro Signorello, Martina Milana, Ilaria Lenci, Leonardo Baiocchi
Roberta Angelico, Bruno Sensi, Tommaso M Manzia, Giuseppe Tisone, Department of Surgery Sciences, HPB and Transplant Unit, University of Tor Vergata, Rome 00100, Italy
Giuseppe Grassi, Alessandro Signorello, Martina Milana, Ilaria Lenci, Leonardo Baiocchi, Hepatology Unit, University of Tor Vergata, Rome 00100, Italy
Author contributions: Angelico R, Sensi B, Manzia TM, Tisone G, Grassi G, Signorello A, Milana M, Lenci I acquisition of data; Angelico R did the analysis and interpretation, drafting of manuscript, critical revision; Sensi B, Manzia TM, Tisone G, Grassi G, Signorello A, Milana M, Lenci I critical revision; Baiocchi L proposal of study, study conception, correction of manuscript, critical revision.
Conflict-of-interest statement: None to disclose by all authors.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Leonardo Baiocchi, MD, PhD, Associate Professor, Hepatology Unit, University of Tor Vergata, Viale Oxford 81, Rome 00100, Italy. baiocchi@uniroma2.it
Received: April 27, 2021
Peer-review started: April 27, 2021
First decision: June 13, 2021
Revised: June 25, 2021
Accepted: November 20, 2021
Article in press: November 20, 2021
Published online: December 7, 2021
Core Tip

Core Tip: Chronic rejection (CR) still represents a cause of graft loss after liver transplantation. Recent advances in understanding the pathways leading to CR, through a T cell-mediated or antibody mediated injury, are opening new strategies for its management. Early detection of CR, tailored immunosuppressive regimen and strict monitoring are essential to prevent graft loss rejection-related requiring re-transplantation. The current perspectives aim to identify non-invasive biomarkers predicting patients at risk for CR in order to prevent irreversible liver damage by adequate immunosuppressive regimen and improving long-term outcomes after liver transplantation.