Early, biopsy-proven acute cellular rejection (EBPR) following liver transplant is associated with poorer graft survival, greater susceptibility to late rejection, and increased vulnerability to infection, according to results published in Clinical Transplantation. David D. Aufhauser, MD, and colleagues classified patients based on EBPR within 90 days of transplant and compared outcomes between groups. In 896 transplants, there were 112 cases (12.5%) of EBPR. Recipients with EBPR had higher biochemical Model for End-Stage Liver Disease scores (28 vs 24; P<0.01), but other donor and recipient characteristics were similar. Recipients with EBPR had similar overall survival compared with patients without EBPR but reduced graft survival (P<0.05). The researchers also discovered an association between EBPR with less time to a first episode of late (>90 days) rejection (P<0.001) and higher vulnerability to infection (P<0.05). In a subgroup analysis of recipients with autoimmune indications for transplant, EBPR had a stronger association with death (HR, 3.9; P<0.05) and graft loss (HR, 4.0; P<0.01).