Rejection is the body's normal reaction to something foreign. When a new liver is placed in a person's body, the body sees the transplanted organ as a threat and tries to attack it. To allow the transplanted liver to successfully live in the body, your child must take antirejection medications to trick the immune system into ignoring the transplanted organ. She will need to take these medications for the rest of her life. Rejection is fairly common, with approximately 40 percent of children experiencing some signs within the first two weeks of surgery. A liver biopsy may be necessary to make the diagnosis. Rejection is treated by adjusting medication doses and does not generally seriously injure the liver in this setting.
Rejection can occur anytime — days, months or even years — after transplant. While the word "rejection" sounds alarming, it's important to remember that rejection is treatable. A rejection episode doesn't mean your child will need another transplant.
Here are some of the symptoms of rejection:
If your child experiences any of these symptoms, you should call her liver transplant coordinator or the transplant office immediately. (At CHOP, if it's between the hours of 8 a.m. and 5 p.m. on weekdays, please call the transplant office at 215-590-4281. At nights and on weekends, you should call 215-590-1000 and ask for the GI fellow on call. This physician will gather all your information and relay it to the pediatric liver transplant team.)
Some or none of these symptoms may occur during a rejection episode. In fact, often, changes in laboratory tests results — such as an increase in liver enzymes — are the only signs of a rejection episode. That's why it's important to keep all scheduled transplant clinic and lab work appointments after your child is discharged from the hospital.
If your child's doctor suspects your child is experiencing rejection, he may order a liver biopsy. The biopsy confirms rejection and allows the physicians to see how much your child's liver has been affected.
If your child does have a rejection episode, he or she may need to be hospitalized for a few days while medications are adjusted.
Reviewed by: Elizabeth B. Rand, MD
Date: November 2012