Rejection

What is Rejection?
Once you have your new organ, you will want to do everything you can to keep it healthy and prevent rejection Rejection is dangerous because it could destroy your new organ. This is why your doctors will be giving you anti-rejection medicines.

It is important that you understand rejection. Once you do, you will see why it is so important to take your medicines the right way.

Rejection happens when the body’s immune system tries to get rid of a transplanted organ. Your immune system is your body’s defense against foreign things. The immune system has an “army” of special cells that are always on guard to protect you from infection and disease. Unfortunately, these cells cannot tell the difference between a harmful virus or bacteria and your new organ. Their natural response is to attack and try to reject a new organ.

Anti-rejection medicines (also called immunosuppressants) slow down your immune system’s “army.” These medicines make it easier for your new transplant to defend itself.

You will probably take more than one medicine to slow down your immune system. Each medicine works in a different way. This gives you better protection against rejection. You may need to take some of these medicines around the clock every day for the rest of your life to protect your new organ.

Even with all the right care and medicines, many transplant patients still have at least one rejection episode. This is more likely to happen within the first few months after the surgery; however, it’s possible that a rejection episode could happen years later. To clarify these different kinds of episodes, transplant rejections are described in four ways: hyperacute, accelerated, acute and chronic.

• Hyperacute rejection is when the body rejects the organ within minutes or hours after transplantation. This is the most rapid form of rejection.
• Accelerated rejection occurs 3 to 4 days after transplantation. Accelerated rejection is usually seen in recipients who have been pre-sensitized by a previous transplant.
• Acute rejection occurs between five and 90 days after transplantation. Acute rejection appears to be a delayed-type reaction. Some common features include edema, fever, and loss of graft function.
• Chronic rejection occurs 3 months after transplant or later. Chronic rejection is an ongoing concern for transplant recipients. In the liver, chronic rejection can cause severe, increasing injury to bile ducts. Similar types of tissue damage are seen in other transplanted organs undergoing chronic rejection.

Fortunately, transplant rejection does not necessarily mean that your organ will fail. It is important to remember that rejection can be successfully treated if it is detected early. Your doctors can usually reverse rejection by changing the doses of your anti-rejection medicines or by using different medicines. The therapy that is frequently used first for these rejection episodes involves high doses of steroids. Antilymphocyte globulin, azathioprine, mycophenolate mofetil, or muromonab-CD3 may also be used.

Warning Signs
Call your transplant team right away if you notice any of the following:

• Fever over 100 degrees F (38 degrees C)
• “Flu-like” symptoms such as chills, nausea, vomiting, diarrhea, tiredness, headache, dizziness, body aches, and pains
• Pain or tenderness over your transplant site
• Retaining fluids or having sudden weight gain
• Shortness of breath
• Sudden rise in blood pressure
• Change in your pulse rate

Kidney transplants only:

• Change in the color (dark yellow or orange) or smell of your urine
• A lower amount of urine

Liver transplants only:

• Yellow color to the skin or eyes
• Light-colored or blackened stools

Your transplant team will need to determine if these are side effects of the medicine, signs of an illness, or a warning that your new organ is being rejected.

Watching out for infection
The medicines you take to prevent rejection work by slowing down your body’s immune system. While they protect your organ from rejection, they also lower your body’s ability to fight infections. Germs are everywhere in the air you breathe, the food you eat, and every object you touch. Everything you come into contact with raises your risk of infection. Good hygiene and frequent hand washing can help reduce this risk.

The good news is that most infections can be treated with medicines. However, infections can become very serious and even lead to death if untreated, so you will need to know the warning signs of infection.

Symptoms of infection
Let your transplant team know right away if you have any of the following symptoms:

• Fever over 100 degrees F (38 degrees C)
• “Flu-like” symptoms such as chills, nausea, vomiting, diarrhea, tiredness, headache, dizziness, body aches, and pains
• Coughing up yellow or green mucus
• A dry cough that lasts for more than 1 week
• Severe diarrhea
• A burning feeling when you urinate
• Vaginal discharge or itching
• A wound that oozes fluid, does not heal, or feels warm
• Swelling, warmth, redness, pain, or tenderness of an arm or leg

Wash your hands often to get rid of germs that can cause infection. In addition, avoid touching your eyes or nose since this is the main way germs are spread.