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 (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 hepatocytes in the graft and permanent renal failure. The peak total bilirubin level was 29.6 mg/dL. Although re-transplantation 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.