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Your immune system has the job of keeping viruses, harmful bacteria and other organisms out of your body. Without medicines, your immune system can see your new liver as something to be attacked.

This is called ‘rejection’. Some level of immune response is quite common and occurs in more than half of liver transplants, usually within five to ten days but possibly at any time.

Rejection following soon after surgery is called ‘acute rejection’. It does not mean that you will lose your new liver but it is very important that doctors stop rejection as early as possible.

Rejection that occurs some time after transplantation is called chronic rejection. It is noticeable by a gradual loss of liver function over time, sometimes years.

To prevent rejection of the new liver, doctors will give you medication to make the immune system less aggressive. This is immunosuppression. You will need to take one or more of these anti-rejection drugs – called immunosuppressants – for the rest of your life.

What are the warning signs of rejection?

The main signs of rejection to look out for are:

  • fever (38°C or over)
  • flu-like symptoms such as chills, aches, fatigue and headaches
  • pain or swelling in the abdomen
  • nausea and vomiting
  • breathlessness
  • itching

If you experience any of these signs, contact your transplant team immediately. It is possible that you won’t have clear symptoms, so it is essential for you to attend clinic as often as you are asked to allow staff to keep an eye on you for other signs of rejection.

Chronic liver rejection takes some time to happen and is more difficult to treat. Fortunately it affects very few people. There is medication to control chronic rejection, but if this does not work another transplant will be needed.

How does immunosuppression work?

To function effectively your immune system relies on certain types of white blood cells that are produced in your bone marrow and lymph glands. Known as T and B lymphocytes, these cells make antibodies that protect the body from invading infections. Immunosuppressant drugs reduce the production of T and B lymphocytes by interfering with the production of genetic material within the cells, known as DNA. This prevents the cells from dividing and multiplying. With fewer white blood cells the immune system is weaker and less able to reject the transplanted organ.

What are the side effects of immunosuppression?

Having a weakened immune system also means that you pick up infections more easily. Immunosuppressants can also interfere with the production of other types of blood cells in the bone marrow.

Having fewer red blood cells can lead to anaemia and a slow down in the production of platelets can cause problems with blood clotting. For this reason, doctors will check levels of all your blood cells during treatment.

Other possible side effects of immunosuppressants are:

  • kidney damage (nephrotoxicity)
  • high blood pressure (hypertension)
  • an increase of blood fats (hyperlipidemia)
  • insulin resistance (diabetes)
  • bone thinning (osteoporosis), if long-term use of steroids is part of your treatment

Again, your transplant team will monitor the concentration of medications in your blood to help avoid or manage any complications.