Rejection of a liver transplant

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Teen boy resting head against a wall and looking sad

Your transplanted liver is new to your body. Because your body thinks the new liver is a foreign body, its first response is to attack it with special fighting cells from your immune system. This is called rejection and is relatively common. Rejection needs to be treated with medication because it can damage your liver.

The immunosuppressants (anti-rejection medications) you will be taking help prevent rejection. Sometimes, however, you can have a rejection even if you take the immunosuppressants exactly as you should. Despite this, you should always take your medications as instructed by your transplant team.

Your body is more likely to have some rejection of your new liver if you decrease your medication dose (take less than you have been prescribed), miss medications or stop taking your medications.

Rejection can be:

  • acute
  • chronic.

Acute rejection

Acute rejection​ can start anytime but is most common in the first few months after transplant. Typically, you will not know if you have acute rejection, as you will not have any symptoms or feel any different.

Regular blood tests help your health care team to monitor your liver. If your liver enzymes begin to rise, the team may suspect rejection. As a result, it is very important that you have your blood work done as ordered by your doctor. It is the only way that your transplant team can be sure if any problems are occurring. Your transplant team can confirm acute rejection by doing a liver biopsy.

Acute rejection is most commonly treated with medication (such as intravenous methylprednisolone followed by extra prednisone by mouth for several weeks). Typically, it does not cause long-term damage to your liver once it is treated quickly.

Chronic rejection

Chronic rejection is a very rare complication that damages the liver slowly over time. It is often the reason a liver can stop working well years after your transplant.

Like acute rejection, chronic rejection can only be diagnosed with a liver biopsy.

Your transplant team may adjust your medications to slow down the process of rejection and allow your liver to work for longer. It is important that you do not change anything related to your medications without talking to your transplant team first.

Chronic rejection can lead to the need for a second liver transplant.

Last updated: November 30th 2017