Which of the following statements about immunology in liver transplantation is/are correct?

B. Hyperacute rejection is almost nonexistent following liver transplantation.

C. Acute rejection occurs in more than 50% of patients and is reversible in most patients with large doses of steroids.

D. Acute rejection is very rare later than 2 months after liver transplantation unless the patient is inadequately immunosuppressed.

E. Chronic rejection is different from acute rejection, is usually irreversible, and often requires retransplantation.

DISCUSSION: Immune-mediated reactions following liver transplantation are clearly different from those that follow other solid organ transplants. The liver is tolerated quite well, and currently donors and recipients are matched only for their ABO group. Even when the ABO barrier is not respected, survival is still over 60%. T cell–mediated acute rejection occurs in about half of the patients within 6 weeks after liver transplantation, and acute rejection is reversed by large doses of steroids in most cases. Chronic rejection, on the other hand, is a different entity that is ill-understood and corresponds to destruction of small arteries and bile ducts. Change in the immunosuppression regimen sometimes may hinder the progression of this disease, but often retransplantation is required.