Liver transplant rejection

The body's immune system is its army to fight disease and infections. The immune system looks for and tries to kill anything it does not recognize to protect the body.

After a liver transplant, your child’s immune system may mistakenly attack the new liver because it sees it as foreign. This is called rejection.

To help prevent this, your child will take medicines to weaken their immune system. However, rejection can still happen, even if medicines are taken correctly.

*The risk of rejection is highest during the first 3 months after the transplant.*

Symptoms of rejection

Fever over 100.4°F (38°C)
Pale or yellowish poop
Yellow eyes
Dark (tea-colored) pee
Extreme tiredness

If you notice any of these, call your transplant team right away.

Rejection can happen if the immunosuppression medicine level in the blood is too low. This might be caused by:

Vomiting (throwing up)
Missing or taking the wrong dose
Switching to a generic medicine
Taking other medicines or herbal supplements that interfere
A change in the dose of immunosuppression medicine

That’s why regular lab tests are so important—to make sure the medicine is working correctly.

What happens if the transplant team is worried that my child has rejection?

If blood tests show high liver enzymes, the team may do:

A liver ultrasound to check liver blood flow and structure
More blood tests to rule out infections
A liver biopsy to look at a small piece of the liver under a microscope

Liver biopsy and treatment

A liver biopsy is the only way to confirm if your child’s body is rejecting the new liver.

Your child may stay in the hospital the night before or come in the same day.
They can’t eat or drink after midnight before the biopsy.
The biopsy is done in Interventional Radiology (IR) while your child is asleep under anesthesia.
A small needle takes a tiny piece of liver through the skin on the upper right belly.
Afterward, your child will lie on their right side to help stop any bleeding.
Blood tests are done a few hours later to check for bleeding.
Most kids feel little or no pain and go home with just a bandage.

A doctor looks at the liver tissue under a microscope to check for rejection.

How Is Rejection Treated?

If rejection is found:

Your child may stay in the hospital for 1 to 7 days.
They’ll get high-dose intravenous (IV) steroids to stop the rejection.
Daily blood tests will check if the liver is improving.
Blood pressure and blood sugar will also be watched closely (steroids can raise both).

If the liver doesn’t improve: