Liver Transplant Evaluation and Assessment Guide

Rejection

The body’s normal response to anything foreign is to defend itself. In the case of an infection due to a foreign virus, fungus, or bacteria, this protective response helps us avoid getting ill. However, in the transplantation of organs, this normal function of the body called rejection is what we seek to prevent. We do this by giving immunosuppressive, or anti-rejection medications.

The primary anti- rejection medications used are Tacrolimus, Prednisolone, Azathioprine, Mycophenolate and Cyclosporin. These are used in combination according to your needs. There are many other immunosuppressive medications that may be used in addition to these.

Every individual needs differing doses of immunosuppression. Some need a lot, some need very little. There is no way to predict this. In spite of all the medications you will receive to prevent rejection, episodes of rejection can still occur.

Rejection occurs most frequently in the first 3 months after transplantation, when we are trying to find the correct level of immunosuppression for you as an individual. These rejection “episodes” are treatable and 9 out of 10 times are reversed with high doses of prednisone. There are other drugs we try if prednisolone does not work. Rejection episodes are part of liver transplant, we are prepared to diagnose and treat the rejection episodes accordingly.

The most common reason that people experience rejection after they leave hospital is that for one reason or another they forget or stop taking their immunosuppression medication. Missing even 1 dose can cause problems and you need to be vigilant about taking your medications every day.

There are very few symptoms when you are experiencing rejection. While in the hospital, and as an outpatient a rejection episode will most likely be recognized by an increase in your liver enzymes and bilirubin levels, on a blood test.

Less common symptoms of rejection may be:

• Fever, a body temperature over 38 degrees Celsius
• Yellowing of the eyes or skin
• A general feeling of unwellness and fatigue.

When we notice a rise in your liver function tests, you will be sent to have an ultrasound to make sure all is well with the blood vessels of the liver. If we are concerned about rejection, a liver biopsy may need to be done. This small sample of tissue will then be reviewed under a microscope. Treatment for rejection will be commenced when we have the biopsy results.

In this guide:

1. Information and contact details for the liver transplant hepatology team
2. The liver - its function and anatomy
3. Signs of liver disease
4. Pre-transplant assessment and evaluation
5. The assessment team
6. Allied Health Services
7. Palliative care
8. Pharmacy—medications before your transplant
9. Case discussion and assessment presentation
10. Will I make the list?
11. The liver transplant waiting list
12. Model for End stage Liver Disease (MELD)
13. Support Through Education Program (STEP)
14. The Donor
15. What happens when you are notified that a donor liver is available?
16. The liver transplant operation
17. Intensive Care Unit (ICU) patient information
18. The recovery period
19. Pharmacy—medications after your transplant
20. Rejection
21. Donor family correspondence and information
22. Glossary

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