Learn About Chronic Liver Transplant Rejection

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What it is

Chronic liver transplant rejection is a possibly non-reversible condition caused by the liver transplant patient’s own immune system. Another form of organ transplant rejection, acute rejection, may be reversible. The acute form occurs within the first few weeks following transplant surgery. Conversely, chronic rejection can occur months or even years following the liver transplant procedure.

What happens in chronic rejection of a transplanted liver is that the antibodies produced by the white blood cells attach to the transplanted organ and signal the entire immune system to attack it as if it were a foreign body. This immune-system attack on the transplanted liver occurs in a slow and continuous manner, though some patients will still retain an acceptable level of organ function, despite it being reduced from the immune-system attack.

A 2008 Medscape article cites the rate of chronic graft rejection as occurring in about 5 percent of patients, adding that this diagnosis is obtained with a liver biopsy. It should be noted that liver biopsies may occur on a regular basis, anyway, as a means of monitoring the status of the transplanted liver.

While most patients do not suffer from chronic rejection of a transplanted liver, those who do are at risk of complete failure of the transplanted organ.

The good news is that steps can be taken to help prevent chronic rejection of a transplanted liver or other organ from occurring.


Organ transplant patients are put on very specific regimen of anti-rejection medications after the surgery has been performed. The medications used may change over the duration of the patient’s lifetime and can include corticosteroids, antiproliferative agents and calcinerurin inhibitors.

It is crucial that this regimen be followed very closely by the liver transplant patient in order to help prevent rejection of the new liver from occurring. Along with this is the admonishment to closely follow the doctor’s orders in regards to lifestyle and recovery, as well as reporting anything unusual to the doctor.


The most common symptoms of liver rejection are:

  • Fever over 100.4 degrees F
  • Jaundice
  • Urine darkening (may be dark yellow or orange)
  • Fatigue
  • Pain over liver; abdominal tenderness or pain
  • Clay-colored stool

If any of these symptoms occur, it is crucial that the transplant recipient immediately contact his or her doctor in order to help avoid, if possible, liver transplant rejection.


Rejection: Organ Transplant. University of Iowa Hospitals and Clinics. https://www.uihealthcare.com/topics/medicaldepartments/surgery/rejection/index.html

Transplants, Liver. Lemi Luu MD, Carin M Van Gelder MD, Steven A Conrad MD, PhD. Last updated September 18, 2008. https://emedicine.medscape.com/article/776313-overview

A Patient’s Guide to Liver Transplant Surgery: Medications & Complications. USC Liver Transplant Program and Center for Liver Disease. https://www.surgery.usc.edu/divisions/hep/patientguide/rejection.html