Understanding Liver Transplantation Rejection and Immunosuppression

Your body needs to have a strong immune system to fight infections and cancer. T-cells from your immune system are always moving through your blood and identifying foreign tissue, like a new organ. A group of molecules called Human Lymphocyte Antigens (HLA) are molecules that tell T-cells that the cells in your body are your own. HLA molecules are available in all of your cells. When you get an organ transplant, your body’s T-cells will notice that the new organ doesn’t have the same HLA antigens as the rest of your body. There will then be a lot of T-cells and other cells in your immune system that will try to get rid of the new organ.

What is Rejection?

Rejection is the body’s natural response to a new thing that it doesn’t know. When a person gets a new liver, their body sees it as a threat and tries to fight it off. The immune system makes antibodies to kill the new organ, but it doesn’t know that the liver transplantation is good for the person who gets it. There are two types of liver rejections.

  • Acute Cellular Rejection: When the body’s blood cells see the liver as foreign, they start making an army of cells to attack the liver. If you get a new organ, acute rejection can happen at any time. It is more common in the first three months after the transplant. There is a way to treat acute rejection. The rejection must be diagnosed and treated as soon as possible. Your blood tests should be done as directed by your transplant center. You should also see your doctor regularly and report any symptoms you are having to your transplant center.
  • Chronic Rejection: This happens when the rejection process doesn’t end or if it goes on for a long time. People who have chronic rejection find it more difficult to treat because the liver tissue changes more permanently and eventually stops working at all, making it more difficult.

What are the signs of Organ Rejection?

After leaving the hospital, you don’t have any blood test to find out if your body rejects the new organ. If your immune system rejects your new organ, you might have some mild symptoms. But some patients may keep feeling good for a while. More than 100° F or 38° C, liver function tests, yellowing of the eyes or skin, and fatigue are the most common early signs of the virus.

As the last step, your doctor may suggest you undergo a liver biopsy. This is to make sure that the rejection causes your symptoms. To find out what is wrong with your liver, you need to check it out.

What is a Liver Biopsy?

A liver biopsy is the only way to ensure that your immune system rejects the new liver transplantation. Most of the time, doctors perform a biopsy as an outpatient or short-stay procedure in the hospital. The doctor looks at a small piece of liver tissue under a microscope to see if the body rejects it. Your symptoms and liver function tests can help you determine if the liver is being rejected. 

The doctor will use an antiseptic solution to clean the area where your liver was. This is to make sure that the area is free of bacteria. The doctor will give you a shot of a local anesthetic in the biopsy area. Then they ask you for an ultrasound to figure out the best place to put the biopsy needle. Afterward, the doctor will put a special needle into the liver and take out a piece of tissue. It might look like a piece of string. During the biopsy, it only takes a few seconds. Pathology labs process and look at the tissue under a microscope. The tissue is put in a special solution and sent to the labs.

Afterward, you will need to stay in bed for 2 to 4 hours. There are many ways your nurse will keep an eye on you after you have a biopsy. They will look at your vital signs, body, blood, and/or any physical complaints. 

How to Find Out that Your Body is Rejecting the New Liver

Taking liver transplantation function tests every few months and watching the pattern of the results can help your doctor find your liver condition. If your blood test results are over the normal range, your transplant doctor or coordinator will talk to you about them. Also, they will tell you what to do next and share liver transplant in India. As you get better after a transplant or a related problem, some abnormal lab results may be OK. They should get better over time. For more detail, please click here!