Liver Transplant Rejection – Signs and Management

Liver transplant rejection, also called organ rejection, is a very serious concern that comes along with liver transplants or other similar procedures. The main cause for rejection is because your immune system attacks the foreign object, i.e. the new liver.

Liver Transplant Rejection Signs

The symptoms and signs of organ transplant rejection include feeling tired all the time, loss of appetite, nausea and vomiting. As the rejection continues, other organ rejection symptoms are observed, such as:

  • Fever
  • Pain in the liver area
  • Change in color of urine. It has a darkish tone
  • The color of your stool becomes pale as bile is not produced
  • Jaundice

These symptoms are commonly observed in most cases. In some liver transplant rejection cases however there may be almost no symptoms of rejection. A liver biopsy is a more definitive way to determine the condition of organ rejection. In a liver biopsy, a small piece of the liver is taken and viewed under a microscope.

If the organ is rejected, then the transplant unit and the doctor will run more tests to see if another transplant would be possible. Once this is confirmed, they will immediately place you on the waiting list. Once the transplant is successfully carried out, you will be shifted to an ICU.

The liver transplant recovery will take time and it is better to stay put in the hospital for three to four weeks at the very least. Once you’re home, there should be no rush to get back to work or to perform household chores. Apply as little stress on the new liver as possible.

Liver Transplant Rejection Management


As the biggest risk to the new liver is caused by the immune system that attacks it, medicines are prescribed to suppress the body’s immune system, thus preventing liver transplant rejection. These medicines are called immunosuppressants. During the first four to five months, there will be a relatively high risk of organ rejection, and this is when the dose of immunosuppressants will be high.

As time goes by, the dosage will either reduce or increase based on how well the new liver is functioning in the body. There are two types of immunosuppressants associated with liver transplants.

Calcineurin Inhibitors

There is a type of white blood cells called T cells, which are used by the immune system to fight off infections. When doing this, the immune system invariably attacks the new liver.

liver transplant rejections

Rashes are side effects that rise when liver transplant rejection is countered

The inhibitors work by shielding the effects of calcineurin, a protein that activates the T cells. Tacrolimus and Ciclosporin are inhibitors which are used widely. They are given either in the form of injections, capsules or tablets.

Tacrolimus Side Effects

Side effects commonly associated with Tacrolimus include:

  • Tremors
  • Sleeping difficulties
  • Rise in blood pressure
  • Loss of hair
  • Seizures
  • Skin rashes
  • Itchy skin
  • Mental fluctuations
  • Diarrhea

Ciclosporin Side Effects

Side effects commonly associated with Ciclosporin include:

  • Numbness in different body parts
  • Vomiting and nausea
  • Chronic headaches
  • Appetite loss
  • Muscle cramps
  • Increase in growth of skin hair
  • Rise in blood pressure
  • Tremors

If you are consuming other medication in addition to these immunosuppressants, it is recommended that you consult your general practitioner or a member of the transplant unit before continuing.

The reaction of the inhibitors with other medicines is not always predictable and can cause catastrophic damage if taken without a consultation.


Corticosteroids act by turning off the gene that releases chemicals, which the immune system uses to attack the donated liver. They penetrate the walls of the cells of the immune system.

liver transplant rejection signs

Corticosteroids are used to work against liver transplant rejection

Prednisolone is the most widely used corticosteroid in the case of liver transplantation rejection. The side effects of prednisolone include:

  • Mood swings
  • Retention of fluid
  • Increase in weight
  • Weakness in muscles
  • Ulcers in throat and mouth

Some people may also develop mental issues when on prednisolone. These may include:

  • Thoughts about suicide
  • Hallucinations (hearing and seeing things which are unreal)
  • Paranoia
  • A state of confusion and unclear thoughts

If you are unsure about the drugs you are taking or have a doubt about the course of medication, consult the surgical team or your medical practitioner immediately.

A study regarding the efficacy of corticosteroids showed that among a select group of 152 patients, 85% who were on them for the recommended doses showed no sign of rejection in the first 72 hours and a 78% probability of having no degeneration in the new liver for a further three months.

You’ll need to stay updated about the many liver transplant rejection signs in order to ensure that management steps are taken right away. Post liver transplant complications must always be checked for once the liver transplant surgery is completed. Always consult your medical practitioner in case you have any doubts or worries.

Liver Transplant Complications – The Risks Involved

Liver transplant complications are common, although the liver transplant surgery is a procedure that is performed on a day to day basis. Listed below are some of the complications that can arise either during or after the procedure.

Liver Transplant Complications – The Many Problems

Liver Transplant Complications #1 – Acute Liver Rejection

This is the most common complication that occurs in almost 40% of the cases in the first two weeks after the procedure. This generally happens when the newly donated liver is attacked by the body’s immune system as it recognizes the new liver as a foreign object. The symptoms associated with acute liver rejection include:

  • Fever (above 100.5 F or 38 degree Celsius)
  • Diarrhea
  • Vomiting
  • Jaundice
  • Dark urine
  • Pale stools
  • Itchy skin

In most cases, these symptoms can be managed by increasing the dose of corticosteroids the patient is on or by replacing the current calcineurin inhibitor with another. In this way acute transplant rejection can be managed successfully.

Liver Transplant Complications #2 – Infection

Infections are another serious worry as the slightest inconsistency can cause an infection of the liver. Calcineurin Inhibitors and corticosteroids are effective antibiotics which make the body’s immune system invulnerable to infections. The most common infections include:

Fungal Infections

Patients who have just had undergone a liver transplant procedure are generally affected by liver transplant problems like candidiasis and aspergillosis. The symptoms brought on by these infections vary generally based on which body part is affected by it. Some of the more common ones are:

  • Itchiness
  • Redness and scaling of the skin
  • A whitish thick fluid discharge from the vagina in case of vaginal infection

Fungal infections are more invasive and hence more serious. These generally attack your bloodstream and lungs (fungal pneumonia). The symptoms associated with these include:

  • Dizziness
  • Shortness of breath
  • Chest pain
  • High temperatures
  • Disorientation and confusion

Minor infections may also get worse if the patient is taking an immunosuppressant. In case any of the below mentioned symptoms persist; it is recommended that you call the transplant team.

Antifungal creams and other tablets can handle non-invasive fungal infections, but in case of invasive infections it is better to get admitted to a hospital where the doctors or the transplant team can begin treatment through a course of antifungal injections.

Antifungal injections are meant to fight off any fungal infections. The injections are administered for months after the transplant. Listed below are a few side effects of Fluconazole, a common antifungal medication.

  • Nausea
  • Indigestion
  • Flatulence
  • Headache
  • Diarrhea
  • Skin rash

CMV Infection (Cytomegalovirus)

The symptoms of Cytomegalovirus include:

  • Shortness of breath
  • Appetite loss
  • Occurrence of ulcers in mouth and stomach
  • High temperature
  • Pain in the joints
  • Visual problems like blind spots

In case you have any doubts regarding a CMV infection, contact a general physician or the transplant unit.

Liver Transplant Complications #3 – Diabetes

Diabetes (type II) is a serious and common complication that affects one out of five people after a liver transplant. Symptoms include:

  • Excessive urination
  • Excessive thirst
  • Feeling very tired
  • Loss of weight
liver transplant complications

Diabetes is one of the main liver transplant complications

Liver Transplant Complications #4 – Kidney Failure

Yet another one among the common liver transplant risks is kidney failure. It may occur within the timeframe of three to five years after the procedure. Under kidney failure, the kidneys lose their ability to filter waste from the blood. Symptoms of kidney failure include:

  • Blood in urine
  • Swollen hands, feet or ankles
  • Fatigue
  • Nausea
  • Shortness of breath

Liver Transplant Complications #5 – Graft Failure

Graft failure is a serious concern for patients undergoing liver transplants as it can affect at least one person in every 14. Under graft failure, the transplanted liver does not function correctly. Its symptoms include:

  • Reduced urine output
  • Seizures
  • Low consciousness levels
  • Muscle spasms
  • Double vision
  • Coma (worst case)

The only cure for this is to transplant a new liver.

Liver Transplant Complications #6 – Post Transplant Lympho Proliferative Disorder

It is a rather rare condition and occurs in one out of 50 people. The symptoms are:

  • Swelling of the lymph nodes
  • Pain in the abdomen
  • Loss of weight
  • High temperature
  • Difficulty in breathing because of swollen tonsils
  • Diarrhea
  • Night sweats

Liver Transplant Complications #7 – Cancer

There is an increased risk of developing cancer among patients who have a transplanted liver. The different types of cancer that can be contracted include:

  • Lymphoma
  • Cervical Cancer
  • Skin Cancer
  • Kaposi’s Sarcoma (cancer that is underneath the skin)
liver transplant complications risks

Patients are prone to liver transplant complications like cancer

A recent multicenter Belgian survey showed that there has been a reduction of almost 60% in the number of complications arising after or during a liver transplant in the last five years. This is definitely heartening information, as the surgical procedure is growing safer by the day.

Although the procedure has several complications, those affected by catastrophic liver damage don’t have a choice and should not be discouraged by these liver transplant complications. Surgical teams today perform operations carefully and every precaution is taken to ensure that the occurrence of these complications is avoided. Patients are also informed of the post liver transplant complications and are informed of other patient’s positive liver transplant stories to help them make informed choices.