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After the Transplant | Other Organs

The steady improvement in success rates in transplantation means that there are a large number of patients with long-functioning grafts.

Advances in medicine, including improvements in surgery and greater understanding in how to use anti-rejection drugs safely and effectively, have contributed to the success of liver transplantation.

There are many types of medications that are used to prevent rejection and there are different formulations of same anti-rejection drug.

Your transplant team will adjust the dose depending upon your risk of rejection, your weight, and other medications that you might be taking.

TYPES OF REJECTION

A rejection episode can occur while on anti-rejection drugs, especially during the first few months after surgery. The word "rejection" can be frightening. However, rejection does not mean that you will lose your new organ. Knowing what rejection is and how it can be prevented or reversed will help reduce your fears.

Three types of rejection can occur after receiving an organ transplant:

• Hyperacute rejection occurs as soon as the donated organ is transplanted. This rarely occurs
• Acute rejection occurs at least a few days after the transplant surgery when the body has had time to identify a foreign invader.
• • Chronic rejection is a very gradual type of graft injury that can occur over months or even years after transplantation

DETECTING REJECTION

A rejection episode can usually be reversed if it is caught early. The transplant team can often detect the first signs of rejection. That is why it is important to keep all appointments with your transplant team.

You should also recognize the signs and symptoms of rejection. Contact your transplant team immediately if you think you might be having a rejection episode.

Symptoms of rejection of a transplanted lung or intestine are listed below:

Lung	Unexplained shortness of breath Chest pain Dry cough General ill feeling Decreased amount of air inhaled and decreased speed of air flow during a breath
Intestine	Fever Diarrhea or change in stool patterns Abdominal distention or pain Flu-like symptoms such as chills, nausea, vomiting, tiredness, headache, dizziness, body aches and pains Weight loss, poor appetite Bloody stools

The following medical tests can be used to detect rejection of a lung transplant.

Lung	Spirometry - Pulmonary Function Testing (PFT) - measures lung function	Worsening PFT may be a sign of lung rejection or infection
	Bronchoscopy (with or without a biopsy) is used to obtain fluid or lung tissue	Bronchoscopy can detect infection or rejection

IMPAIRED FUNCTION AND LOSS OF THE TRANSPLANT

In addition to rejection, there are other reasons why a transplanted organ may not function as well as it should. If your organ is not working well but you are not experiencing rejection, your doctor will be able to explain what is happening and provide the appropriate treatment.

For example, inflammation of the small airways (bronchial tubes) of the lung may occur after lung transplantation. It may progress to permanent lung injury (bronchiolitis obliterans or obliterative bronchiolitis) with scarring.

References
Young. Circulation. 1999;100:458-460
Ramakrishna. Ann Card Anaesth. 2009;12:155-65