What is acute rejection of the liver?

Rejection is a signal that your immune system has identified your new liver as foreign tissue and is trying to get rid of it. Preventing rejection with immunosuppressive medications is the first priority. An episode of rejection of the transplanted liver is very common, occurring in as many as 60% of liver recipients. Most people experience a rejection episode within 5 to 10 days of the transplant operation. The signs you and your doctors and nurses are watching for include a low-grade temperature, decreased appetite, abdominal discomfort, joint and/or back pain, tenderness over the liver, increased abdominal fluid, and feeling like you might have the flu. Other signs include an elevation of your liver function blood tests, a change in the color of your bile (from dark green to light yellow), and a decrease in the amount of bile produced.

Because most people do not have obvious signs of rejection, your liver function tests are monitored closely. If they are abnormal, a liver biopsy may be performed to confirm that you are experiencing a rejection episode. A liver biopsy is accomplished at the hospital bedside.

The upper part of your incision is closed by staples, which are removed several days after your surgery. This permits access to the new liver by a biopsy needle. A liver biopsy usually is not painful, but you will feel pressure when the needle is inserted into the liver. Liver biopsies also can be performed on an outpatient basis. This kind of procedure may be necessary if your liver function tests rise after you go home from the hospital.

If you have an episode of rejection, the amount of antirejection medication you are taking will be increased or a different combination of antirejection medications will be prescribed. In almost all cases, adjusting the medications will stop the rejection episode.