Rejection is when your body’s immune system starts to ‘attack’ yourtransplanted liver. It happens when your immune system recognises the liver as coming from a different person and thinks it isn’t supposed to be there.
Rejection can still occur even if you’re taking all of your medicines. If you don’t take yourmedicinesas prescribed, the risks of rejection are higher. It’s very important to take all of your tablets exactly as they are prescribed for you.
Rejection happens in up to 30 in 100 patients.
The risk of rejection is highest in the first 6 months after a transplant. After this time, your body’s immune system is less likely to recognise the liver as coming from another person.
Chronic rejection happens in 2 in 100 patients.
Chronic rejection occurs after 6 months. Chronic rejection is when your body’s immune system continues to attack the donated liver. Even if you take your anti-rejection medications, rejection can still occur. This is why it’s important to keep your appointments in clinic, and take the tablets that have been prescribed for you.
It may be possible to treat chronic rejection if identified early. But if untreated it sometimes it may cause progressive liver failure, which may lead to death or require re-transplantation
Chronic rejection usually leads to the loss of bile ducts (ductopenia). Another liver transplant may be needed.
Rejection is suspected when the liver starts to work less well. This is usually first picked up on blood tests. Occasionally, patients notice that they are jaundiced (yellow).
Diagnosis usually requires a liver biopsy, where a sample of the liver tissue is removed with a needle to look at under a microscope.
A biopsy is usually done using local anaesthetic to numb the skin. There are risks of bleeding and damage to the transplant, but these are rare. Your transplant team will explain the risks of having a biopsy to you.
Your health and your transplanted liver will be closely monitored in clinic
Treatment is with stronger immunosuppressantmedicines.
If the transplant rejection is picked up early, it can usually be treated successfully. It is possible for rejection to cause an organ to fail completely, but this is unusual.
The treatment will depend on the type of rejection you have.
There are different types of rejection, depending on which parts of the immune system are attacking the organ. Different types of rejection need different treatments.
The risk of rejection is commonest in the first 6 months after liver transplant (early). Beyond this, as long as patients remember to take their prescribed immune suppression, at the correct dosage, late rejection is much less common.
Approximately 80 in 100 of patients who experience acute rejection will need higher-dose steroids (usually intravenously for three days) as treatment and this will resolve the rejection. 20 in 100 will need more than one course or require more powerful anti-rejection treatment. On occasion, antibodies specific to the donor organ can develop and this type of rejection may need anti-thymocyte globulin (ATG) treatment.
Rejection is a rare cause of graft loss.Graft loss is when the transplanted liver stops working. If this happens, a second transplant may be an option.
Make sure you attend all of your appointments in clinic, and take the medications that have been prescribed for you. If you have side effects from your anti-rejection medicines, tell your transplant team so that they can talk to you about other options. Do not stop taking your immunosuppressant (anti-rejection) medicines.
