The body's immune system protects a person from infection by recognizing certain foreign substances, such as bacteria and viruses, and destroying them. Unfortunately, the immune system recognizes a new liver as a foreign substance also.
Rejection is an attempt by the immune system to attack the transplanted liver and destroy it. To prevent rejection from occurring, a recovering patient must take immunosuppressive medications, as prescribed, for the rest of his life.
In spite of all precautions, rejection episodes can occur. Up to 75% of all liver-transplant recipients will have at least one rejection episode, even though these people are taking immunosuppressants. The first episode often occurs within 2 months of surgery. Rejections are usually controlled by changing the dosages of immunosuppressive medications or temporarily adding a new one.
If detected early, most rejection episodes can be treated successfully. A patient should be alert to the signs and symptoms of rejection and inform his transplant team promptly if he has the following.
- fatigue
- fever
- abdominal pain or tenderness
- dark yellow/orange urine
- clay-colored stools
A patient may not have any symptoms, but his liver-function tests may be abnormal, suggesting that rejection is occurring. This is why maintaining a strict appointment schedule with the transplant team is critical.
When rejection is suspected, it is usually confirmed by a liver biopsy. Based on the results, the transplant team will decide the best treatment. As with all transplant patients, a patient may have biopsies at regular intervals to monitor his liver function.
