title: Late acute rejection in liver transplant: a systematic review.
abstract: BACKGROUND
  Late acute rejection leads to worse patient and graft survival after liver transplantation.
  
  
  OBJECTIVE
  To analyze the reported results published in recent years by leading transplant centers in evaluating late acute rejection and update the clinical manifestations, diagnosis and treatment of liver transplantation.
  
  
  METHODS
  Systematic literature review through Medline-PubMed database with headings related to late acute rejection in articles published until November 2013 was done. Were analyzed demographics, immunosuppression, rejection, infection and graft and patient survival rates.
  
  
  RESULTS
  Late acute rejection in liver transplantation showed poor results mainly regarding patient and graft survival. Almost all of these cohort studies were retrospective and descriptive. The incidence of late acute rejection varied from 7-40% in these studies. Late acute rejection was one cause for graft loss and resulted in different outcomes with worse patient and graft survival after liver transplant. Late acute rejection has been variably defined and may be a cause of chronic rejection with worse prognosis. Late acute rejection occurs during a period in which the goal is to maintain lower immunosuppression after liver transplantation.
  
  
  CONCLUSIONS
  The current articles show the importance of late acute rejection. The real benefit is based on early diagnosis and adequate treatment at the onset until late follow up after liver transplantation.
authors.affiliation: School of Medicine, University of São Paulo, São Paulo, SP, Brazil.
authors.forename: Lucas Souto
authors.initials: LS
authors.lastname: Nacif
authors.affiliation: School of Medicine, University of São Paulo, São Paulo, SP, Brazil.
authors.forename: Rafael Soares
authors.initials: RS
authors.lastname: Pinheiro
authors.affiliation: School of Medicine, University of São Paulo, São Paulo, SP, Brazil.
authors.forename: Rafael Antônio de Arruda
authors.initials: RA
authors.lastname: Pécora
authors.affiliation: School of Medicine, University of São Paulo, São Paulo, SP, Brazil.
authors.forename: Liliana
authors.initials: L
authors.lastname: Ducatti
authors.affiliation: School of Medicine, University of São Paulo, São Paulo, SP, Brazil.
authors.forename: Vinicius
authors.initials: V
authors.lastname: Rocha-Santos
authors.affiliation: School of Medicine, University of São Paulo, São Paulo, SP, Brazil.
authors.forename: Wellington
authors.initials: W
authors.lastname: Andraus
authors.affiliation: School of Medicine, University of São Paulo, São Paulo, SP, Brazil.
authors.forename: Luiz Carneiro
authors.initials: LC
authors.lastname: D'Albuquerque
mesh_terms: D000208:Acute Disease; D006084:Graft Rejection / Q000175:diagnosis / Q000628:therapy; D006801:Humans; D016031:Liver Transplantation; D013997:Time Factors