Preventing Organ Rejection After Transplant

Each year, thousands of people undergo transplant surgery. An organ transplant can save your life if you have serious organ damage.

Transplants sometimes fail because the body rejects the organ. Understanding why rejection happens and how to prevent it can help you protect your new organ.

What causes transplant rejection?
Your body has a powerful set of defenses called the immune system. It attacks anything in your body it sees as an invader, such as germs or toxins. This immune system response helps protect you from infections and diseases.

The normal immune response can be dangerous when you have an organ transplant. Doctors will try to get an organ that closely matches your tissue. Still, it will not be exactly the same. The immune system can recognize the difference and will try to destroy the new organ. This is called rejection.

When rejection occurs, it usually happens quickly, most often within the first year after surgery. This is called acute rejection. In some cases, it is a slow, gradual process that happens months or even years after the transplant. This is known as chronic rejection.

How is transplant rejection prevented?
To prevent rejection, you will need to take medicines that weaken (or suppress) the immune system. These are called anti-rejection drugs, or immunosuppressants. Some of the more common immunosuppressant medicines are:

• Corticosteroids such as prednisone (Deltasone)
• Cyclosporine (Sandimmune, Neoral)
• Azathioprine (Imuran, Azasan)

You may need to take two or three of these medicines to suppress different parts of the immune system. Right after surgery, when the risk of rejection is highest, you will take high doses. Later, your doctor may reduce the doses. But you will probably need to take anti-rejection medicines for the rest of your life.

What are the side effects of these medicines?
To prevent organ rejection, these medicines weaken the immune system. While this protects the organ, it weakens your defense against infection. For this reason, it's important to take steps to prevent infections in your body.

Other side effects depend on which medicines you take. Most side effects are mild and will go away once your body gets used to the medicine. Other side effects can be very serious. Your doctor can tell you what side effects to expect. Common ones include:

• Nausea or vomiting
• Diarrhea
• Loss of appetite
• Trembling or shaking (tremor)

If you have severe or persistent side effects, call your doctor. Do not stop taking your medicines unless your doctor tells you to.

Immunosuppressants can cause serious long-term side effects. These include high cholesterol, high blood pressure and osteoporosis. Some can also increase your risk of bleeding and cancer. Your doctor can give you treatments and precautions to help minimize these risks.

What symptoms should I watch for?
Once you've had a transplant, you will need to watch for symptoms that could mean your body is rejecting the organ. Call your doctor right away if you have any of the following:

• Fever
• Pain, tenderness or swelling at the site of the transplant
• Flu-like symptoms, such as chills, aches, headache, fatigue, nausea or vomiting
• A return of your symptoms of organ failure (for example, less urine if you had a kidney failure or shortness of breath if you had heart failure)

Rejection can often be stopped with quick treatment.

Sources:

Jurt U, Delgado D, Malhotra K, Bishop H, Ross H. Heart transplant: What to expect. Circulation. 2002;106:1750-1752. Accessed November 20, 2007.

Sykes M. Transplantation immunology. In: Goldman L, Ausiello D, eds. Cecil Medicine, 23rd ed. Philadelphia, PA: Saunders Elsevier. Accessed November 20, 2007.

United Network for Organ Sharing. Medications: Protecting your transplant. Accessed November 20, 2007.