Rejection is common following liver transplantation. Your body recognises the transplanted liver as a foreign object and tries to destroy it through a process known as rejection. It is not uncommon to experience one or more episodes of rejection during their recovery period. It most commonly occurs 7 - 10 days after surgery. It is controlled in over 90% of cases by transient increases in medication.
The chances of rejection diminish with time, but rejection can occur at ANY TIME following transplantation. Therefore, it is important that you be aware of signs and symptoms of rejection.
Signs and symptoms of rejection may include:
Fatigue, lethargy or malaise
Lack of appetite
Fever
Abdominal pain or tenderness
Light coloured stools (faeces from the bowel)
Dark coloured urine
Yellow eyes and skin
Elevations in liver function tests
Flu-like symptoms - fever, joint and muscle pain.
If you develop any of these signs or symptoms of rejection once you leave hospital, notify the Liver Transplant team. However these symptoms do not always appear before a rejection episode. Many episodes are picked up by routine blood tests at the time of your outpatient visits. A biopsy may be required to make a definitive diagnosis.
Rejection may be mild or severe. In most cases, liver rejection can be controlled satisfactorily if treated promptly.
There are many methods for controlling rejection and they may include:
- Tacrolimus or Cyclosporin dosage readjustment
- Intravenous steroids (IV methylprednisolone) (a ‘pulse’)
- Other immunosuppressive drugs such as Imuran, Cellcept or OKT3.
The onset of rejection does not mean that your liver will be lost but prompt treatment is important.
Very rarely, a transplanted liver fails to function or undergoes irreversible rejection. There is no dialysis treatment for livers as with kidneys. Thus, if a liver fails completely, the only hope is for a second transplant.