[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-seo-432371-105":3,"detail-sidebar-cat-0-en-105":81,"doc-detail-432371-en":131},{"code":4,"msg":5,"data":6},0,"ok",{"site_id":7,"language":8,"slug":9,"title":10,"keywords":11,"description":12,"schema_data":13,"social_meta":74,"head_meta":76,"extra_data":78,"updated_unix":80},105,"en","successful-recovery-from-a-severe-graft-dysfunction-due-to-acute-rejection-after-liver-transplantation-a-case-report","Successful Recovery From a Severe Graft Dysfunction Due to Acute Rejection After Liver Transplantation - A Case Report","","Graft failure remains a major challenge after liver transplantation, and rejection is a leading cause. This case report describes a rare instance of severe graft dysfunction from acute rejection that recovered without re-transplantation. A 58-year-old man with hepatocellular carcinoma on alcoholic cirrhosis underwent deceased donor liver transplantation. On postoperative day 23, about 90% hepatocyte destruction and permanent renal failure occurred, with peak bilirubin 29.6 mg/dL. Although retransplantation was considered, severe donor shortage in Japan made it infeasible. Conservative, meticulous management for four months enabled graft recovery and return to work.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/document/","Document",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/document/healthcare/","Healthcare",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/document/successful-recovery-from-a-severe-graft-dysfunction-due-to-acute-rejection-after-liver-transplantation-a-case-report/432371/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/successful-recovery-from-a-severe-graft-dysfunction-due-to-acute-rejection-after-liver-transplantation-a-case-report/432371.png","ImageObject",300,407,{"name":42,"@type":43},"Marglet","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-11-07","2026-09-29",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",13,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"What caused severe graft dysfunction in this case after liver transplantation?","Question",{"text":63,"@type":64},"Severe acute rejection caused destruction of approximately 90% of hepatocytes in the graft, along with permanent renal failure.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"Why was re-transplantation not performed despite considering it?",{"text":68,"@type":64},"Retransplantation was not feasible because of the severe donor shortage in Japan.",{"name":70,"@type":61,"acceptedAnswer":71},"How did the patient ultimately recover?",{"text":72,"@type":64},"Comprehensive and meticulous conservative medical management was continued for about four months until the liver graft recovered, allowing the patient to return to work.","https://schema.org",{"og:url":32,"og:type":75,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":77,"canonical":32},"index,follow",{"doc_id":79,"site_id":7},432371,1790764895,{"code":4,"msg":82,"data":83},"success",[84,88,92,96,101,106,110,115,120,123,127],{"id":22,"doc_module":4,"doc_module_name":25,"category_name":85,"show_sort_weight":86,"slug":87},"Story & Novel",90,"story-novel",{"id":26,"doc_module":4,"doc_module_name":25,"category_name":89,"show_sort_weight":90,"slug":91},"Literature",80,"literature",{"id":33,"doc_module":4,"doc_module_name":25,"category_name":93,"show_sort_weight":94,"slug":95},"Exam",70,"exam",{"id":97,"doc_module":4,"doc_module_name":25,"category_name":98,"show_sort_weight":99,"slug":100},5,"Comic",60,"comic",{"id":102,"doc_module":4,"doc_module_name":25,"category_name":103,"show_sort_weight":104,"slug":105},6,"Technology",50,"technology",{"id":107,"doc_module":4,"doc_module_name":25,"category_name":29,"show_sort_weight":108,"slug":109},7,40,"healthcare",{"id":111,"doc_module":4,"doc_module_name":25,"category_name":112,"show_sort_weight":113,"slug":114},8,"Research & Report",30,"research-report",{"id":116,"doc_module":4,"doc_module_name":25,"category_name":117,"show_sort_weight":118,"slug":119},9,"Religion & Spirituality",20,"religion-spirituality",{"id":118,"doc_module":4,"doc_module_name":25,"category_name":121,"show_sort_weight":118,"slug":122},"World Cup","world-cup",{"id":124,"doc_module":4,"doc_module_name":25,"category_name":125,"show_sort_weight":124,"slug":126},10,"Lifestyle","lifestyle",{"id":128,"doc_module":4,"doc_module_name":25,"category_name":129,"show_sort_weight":97,"slug":130},19,"General","general",{"code":4,"msg":82,"data":132},{"doc_id":79,"user_id":133,"nickname":42,"user_avatar":134,"doc_module":4,"category_id":107,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":55,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":111,"language":140,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":12,"update_tm":144,"read_time":118,"preview_page_count":4},2336477982702,"https://ap-avatar.wpscdn.com/davatar_9964176cb1d06d4a9deccf72a44ae3dc","Review began 10/26/2025  \nReview ended 11/26/2025  \nPublished 12/05/2025  \n© Copyright 2025  \nIsokawa et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CCBY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited.  \nDOI: 10.7759/cureus.98504  \nOpen Access Case Report  \nSuccessful Recovery From a Severe Graft Dysfunction Due to Acute Rejection After Liver Transplantation: A Case Report  \nMarina Isokawa 1, Ryoichi Goto 1, Takuji Ota 1, Norio Kawamura 1, Masaaki Watanabe 2, Tsuyoshi Shimamura 3, Akinobu Taketomi 1  \n1. Gastroenterological Surgery, Hokkaido University Graduate School of Medicine, Sapporo, JPN 2. Department of Transplant Surgery, Hokkaido University, Sapporo, JPN 3. Division of Organ Transplantation, Hokkaido University Hospital, Sapporo, JPN  \nCorresponding author: Ryoichi Goto, [r-gotoh@mba.ocn.ne.jp](r-gotoh@mba.ocn.ne.jp)  \nAbstract  \nGraft failure remains a major challenge after liver transplantation (LT), and rejection is one of its leading causes. We report a rare case of severe graft dysfunction due to acute rejection that successfully recovered without re-transplantation. A 58-year-old man with hepatocellular carcinoma (HCC) secondary to alcoholic liver cirrhosis was registered on the waiting list for deceased donor LT. He developed intractable ascites and renal dysfunction caused by hepatorenal syndrome and subsequently underwent deceased donor LT. On postoperative day 23, severe acute rejection resulted in the destruction of approximately 90% of hepatocytesin the graft and permanent renal failure. The peak total bilirubin level was 29.6 mg/dL. Although retransplantation was considered, it was not feasible due to the severe donor shortage in Japan. Comprehensive and meticulous medical management was continued for approximately four months, and the liver graft eventually recovered, allowing the patient to return to work. This rare case demonstrates successful recovery from severe liver graft failure after transplantation through conservative treatment, and identifying clinical parameters that predict graft recovery may help determine optimal treatment strategies.  \nCategories: Transplantation, Gastroenterology  \nKeywords: graft failure, graft rejection, hyperbilirubinemia, renal dysfunction, renal failure  \nIntroduction  \nThe development of immunosuppressive agents such as calcineurin inhibitors (CNIs) and advances in various surgical techniques and perioperative care have greatly improved clinical outcomes after liver transplantation (LT) over the past decades [1,2] . However, graft failure remains a serious complication that occurs occasionally and is an indication for re-transplantation (re-LT) . Re-LT may be required in certain cases, with rates reported as 5-22% worldwide and 3% in Japan [3,4] . One of the leading causes of graft failure is rejection [3,5] . Here, we report a case of deceased donor liver transplantation (DDLT) in a patient with pre-transplant renal dysfunction, who suffered graft dysfunction with more than 90% hepatocyte  \ndestruction due to acute allograft rejection (AR), but successfully recovered without re-LT.  \nCase Presentation  \nA 58-year-old man was referred to our LT unit with alcoholic liver cirrhosis. He had previously undergone radiofrequency ablation and transcatheter arterial chemoembolization (TACE) for two hepatocellular carcinomas (HCCs) located in segments 5 and 6 five years earlier. He subsequently developed intractable ascites requiring repeated drainage and renal dysfunction due to hepatorenal syndrome. Esophageal varices were treated with endoscopic injection sclerotherapy. The patient had abstained from alcohol for 18 months before being registered on the waiting list for DDLT. Computed tomography (CT) performed for registration revealed a recurrent HCC (25 × 25 mm) in segment 4, which was treated with TACE during the w","cbCaiujdIeqkOUnZ","https://ap.wps.com/l/cbCaiujdIeqkOUnZ","pdf",3164901,"English","# Abstract\n# Introduction\n# Case Presentation\n## Medical history and pre-transplant course\n## Transplantation and postoperative course","[{\"question\":\"What caused severe graft dysfunction in this case after liver transplantation?\",\"answer\":\"Severe acute rejection caused destruction of approximately 90% of hepatocytes in the graft, along with permanent renal failure.\"},{\"question\":\"Why was re-transplantation not performed despite considering it?\",\"answer\":\"Retransplantation was not feasible because of the severe donor shortage in Japan.\"},{\"question\":\"How did the patient ultimately recover?\",\"answer\":\"Comprehensive and meticulous conservative medical management was continued for about four months until the liver graft recovered, allowing the patient to return to work.\"}]","Successful Recovery From a Severe Graft Dysfunction Due to Acute Rejection After Liver Transplantation - A Case Report | PDF",1790659380]