Organ Rejection

Organ rejection is a very specific problem that can occur after transplantation.

Because your child's new liver comes from another person, their immune system will recognize that the liver is different and may try to attack it. If your child's immune system injures the liver, this is called rejection.

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

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

Treatment for rejection involves increasing the amount of medicine to suppress your child's immune system, and allowing the liver to recover from the rejection injury. This usually includes increased steroid doses, but may also require additional medications.

If we think rejection is happening, we take a biopsy, inserting a needle into your child's liver and taking a small sample of tissue. Looking at the biopsy under a microscope, we will be able to see injury to the liver caused by the immune system.

Your child will be asleep for this procedure and may need to stay in the hospital overnight afterwards.

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 IV steroids for several days. Other medicines can be used if this therapy does not work.


Chronic rejection occurs slowly over time. In this case, the liver develops a lot of scar tissue, which is the result of injury from the immune system over a long period of time.

Chronic rejection is very difficult to reverse, and our care focuses on maintaining liver function for as long as possible. Your child may not require another transplant for years.

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

The most common rejection symptoms include:

  • Fever
  • Abdominal pain
  • Jaundice (yellow skin and eyes)
  • Changes in stool or urine color

Every child is different, and some or none of these symptoms may occur during a rejection episode. Increases in liver function lab tests are often the only hint of a problem.

Your child's transplant team will instruct you on who 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 medicines 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 medicines on a strict daily schedule. Not following all medical instructions can result in liver 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 liver and overall health.