_ A person with a new liver must take medications for the rest of
his or her life. The immune system works to protect the body from
invading bacteria, viruses and foreign organisms. Unfortunately, the
body cannot determine that the newly transplanted liver serves a helpful
purpose. It simply recognizes it as something foreign and tries to
destroy it.
In rejection, the body's immune system attempts to
destroy the newly transplanted liver. Without the intervention of
immunosuppressive drugs, the patient's body would reject the newly
transplanted liver. If rejection is not treated, the new liver will not survive. When found early, rejection can be treated by using additional anti-rejection medicines.
Although the medications used to prevent rejection
act specifically to prevent the new liver from being destroyed, they
also have a general weakening effect on the immune system. This is why
transplant patients are more likely to get certain infections. To
prevent infections, the patient must also take preventive medications.
After a liver transplantation, there are three types of graft rejection that may occur:
Hyper acute rejection happens within minutes to hours after the transplant procedure. Preformed anti-donor antibodies cause hyper acute rejection.
Acute rejection
is usually seen within days or weeks of the transplant. Acute rejection
is the most common and the primary target of immunosuppressive agents.
Chronic rejection is the presence of any sign and symptom of rejection after 1 year.
The cause of chronic rejection is still unknown but an acute rejection is a strong predictor of chronic rejections. Liver rejection may happen any time after the transplant.
Lab findings of a liver rejection include abnormal AST, ALT, GGT and
liver function values such as prothrombin time, ammonia level, bilirubin
level, albumin concentration and blood glucose. Physical findings
include encephalopathy, jaundice, bruising and bleeding tendency. Other
nonspecific presentation are malaise, anorexia, muscle ache, low fever,
slight increase in white blood count and graft tender.
Know the Symptoms of Rejection Transplant rejection responds to treatment better if treated promptly.
Increase in bilirubin level or other liver enzymes
Increased temperature (over 100° F or 37.7°C)
Jaundice – yellow color seen in skin and white part of eye (sclera)
Dark (tea-colored) urine
Clay-colored stools
Tenderness over liver site
Achy or flu-like symptoms
Change in color of bile
If rejection is suspected, a liver biopsy will need to be done.