Severe acute allograft rejection 22 years after liver transplantation
Bibliographic record
Abstract
Early acute cellular rejection occurs commonly within the first month after liver transplantation, is easily reversible with treatment, and has little impact on long-term graft survival. In contrast, late allograft rejection, typically defined as occurring after 3-6 months post-transplantation, can lead to the development of chronic rejection and graft loss. Alloreactivity and the risk of rejection decreases with time, since transplantation and many long-term liver transplant recipients can maintain graft function with minimal immunosuppression. We describe a case of acute allograft rejection 22 years and 5 months after liver transplantation. The patient, transplanted for biliary atresia as a young child, had three prior episodes of allograft rejection: two within the first month of transplantation, and one 4 years after. Subsequent to this, she had normal liver biochemistry and was maintained on minimal immunosuppression for many years. Following a diagnosis of immune thrombocytopenic purpura and marginal zone lymphoma, she was switched from tacrolimus to mycophenolate monotherapy, and subsequently developed significantly elevated liver enzymes, and biopsy confirmed severe acute allograft rejection. Our experience demonstrates that despite the liver being an immunotolerant organ, which often can be maintained with minimal immunosuppression post-transplantation, acute allograft rejection can occur at any stage and should always be considered as a possible cause of liver biochemistry abnormalities.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".