Organ Rejection

Organ rejection is a very specific problem that can occur after transplantation. Because a new intestine comes from another person, your child's immune system will recognize that the intestine is different and may try to attack it. If your child's immune system injures the intestine, this is called rejection.

Rejection does not necessarily mean that your child will lose the intestine. If detected early, most rejection episodes can be treated successfully.

The Two Types of Rejection


Acute rejection most commonly occurs within the first six months after transplant. It is not unusual to see a rejection episode 7 to 14 days after surgery.

Don't get discouraged. This is why we check your child so closely with lab work and other tests. If rejection is diagnosed, we will start intravenous (IV) steroids for several days. Other medicines can be used if this therapy does not work.


Chronic rejection occurs slowly over time. Chronic rejection is very difficult to reverse, and our care focuses on maintaining intestinal function for as long as possible. Your child may not need intravenous feeding or another transplant for years.

For the new organ to live successfully in your child's body, we must give your child medicines that suppress the immune response.

The possibility for rejection is greatest soon after transplant. But at any point your child's immune system may try to attack the intestine. To prevent this from happening, your child will take medicines for as long as the intestine is in place.

The most common rejection symptoms include:

  • Increased stomal output
  • Color change in the stoma
  • Watery and/or severe diarrhea
  • Chronic diarrhea
  • Change in the stool pattern
  • Vomiting
  • Stomach area bloating
  • Stomach area pain or tenderness
  • Fever
  • Positive blood culture

Every child is different and some or none of these symptoms may occur during a rejection episode.

Your child's transplant team will instruct you on whom to call right away if any of these symptoms occur.

Not Following Instructions (Non-Adherence)

When a patient or family is not following the transplant team's instructions, we use the term non-adherence. This can mean not taking medications properly, not getting blood draws on time or not getting the medical follow-up that is needed.

Some transplants fail because of non-adherence on the part of patients and families.

Remembering to take medications is very important.

At the time of transplantation, your child will receive medicines to suppress the immune system. The type or combination of medicines depends on many factors.

You and your child must be committed to taking the prescribed doses of these medications on a strict daily schedule. Not following all medical instructions can result in intestinal failure for your child.

While it is important that your child learn responsibility for taking their own medications, children and teens will often forget or delay doing the things that they need to do. You must supervise your child's medication schedule for the sake of your child's intestine and overall health.