Important
If you have symptoms of rejection, please contact us urgently or attend your local emergency department.
What is rejection?
Rejection is a natural process controlled by your immune system. Your immune system protects you by removing anything that it recognises was not part of your body from birth.
The immune system is very powerful and complicated. It is made up of many specialist cells and proteins called antibodies. Their job is to search for things that shouldn’t be there, such as bacteria, viruses and cancer cells, and to destroy them.
It works by recognising that these things are not a normal part of your body and it then tries to get rid of them.
Your immune system is usually very good for you because, if a germ causes an infection to develop, your body can fight it off to get better.
Unfortunately, your immune system can’t tell the difference between a germ and a transplanted organ. After a transplant, the body tries to fight off the new transplanted organ and this is called rejection. Rejection can happen to anyone who has had a transplant.
Are there different types of rejection?
There are three different types
What are the signs and symptoms of rejection?
Most people feel generally unwell when they start to develop rejection although sometimes you may not notice any symptoms at all.
This is why it’s very important to come for your check-ups, to have your regular blood tests and to let us know if you’re not well. If you are developing rejection, you may feel more tired than usual and may have a slight temperature.
In many cases, it can feel like having flu. If rejection isn’t treated, it can affect your breathing and stop some of your other organs from working properly. Rejection can make you very ill and you could even die if you don’t start treatment as soon as possible. Rejection usually comes on gradually over a few days but it can happen very quickly.
You may experience
- Feeling lethargic or more tired than normal
- Feeling like you have flu
- Poor appetite
- Tummy upset such as vomiting, diarrhoea or tummy ache
- Feeling breathless
- Not passing as much urine as normal
- Weight gain or swelling of your ankles, legs, tummy or face
- Palpitations or feeling your heartbeat is faster or more irregular than normal
- Mild fever
The symptoms of rejection can be very similar to when you have an infection.
This is why it’s really important to let your parents or carer know when you feel unwell even if you do not want to or worry about telling them. It is also very important to let the transplant team know.
When might rejection happen?
It is most common in the first few months after a transplant but can happen at any time.
What tests might the transplant doctors need to do?
The common tests you may need include:
- An echocardiogram (echo heart scan) to look at how your heart is working and whether there are any collections of fluid around your heart
- An electrocardiogram (ECG) to look at the electrical activity and rhythm of your heart
- A chest x-ray (CXR) to look at the size of your heart and to check for fluid in your lungs
- Blood tests to look for signs of infection or to find out whether there are any antibodies in your bloodstream.
- Also, a biopsy can check whether you have rejection or confirm that rejection has been successfully treated. Tiny pieces of muscle are taken from the inside of your heart and are then checked in the laboratory. Most children have this done whilst under an anaesthetic but most adults have it done whilst awake.
- An angiogram may be needed to check whether you have chronic rejection. This involves using a special dye to check your coronary arteries for narrowed areas. It may be done as a CT scan or in the cardiac catheter laboratory. Some children, depending upon their age, have this done under an anaesthetic.
Can rejection be treated?
Rejection can be treated and it’s much better to treat it early before it makes you very unwell. This is why you should tell your parents or carers if you don’t feel well. They can then speak to your transplant team. Powerful medicines are available to treat rejection and usually they work quickly. Most children soon feel better once they are treated.
How can I help stop rejection happening?
The medicines you take every day help prevent rejection and are vitally important. They work by making your immune system less efficient so it can’t try to attack your new heart.
The most common medicines used are:
- Ciclosporin
- Tacrolimus
- Mycophenolate mofetil (MMF)
- Azathioprine
- Prednisolone
- Sirolimus
- Myfortic.
You will be taking at least one of these medicines and you may be on more than one.
- Do not stop taking your medicines. This will cause rejection to develop. The rejection may not happen straight away but it will happen at some point. If it’s not treated quickly, you will become seriously ill and might die.
- You can help prevent rejection by taking your medicines at the correct times and taking the correct dosages.
- Please always check with us before you start taking something new. Some medicines including over the counter medicines and herbal remedies, can also affect the amount of immunosuppression in your body.
- Grapefruit also affects your immunosuppression levels and you shouldn’t eat it or drink juice which contains grapefruit
Can rejection happen even if I take my medicines?
It is less likely that you will develop rejection if you take the correct amount of your medicines at the right times but it can still happen. This is why you need to know what rejection might feel like.
Always have your regular blood tests and check-ups.
If the medicine slows down the immune system, why do I not get more infections?
The amount of the medicines that you are taking is changed by your transplant doctors depending upon your blood test results.
It is a balancing act:
- Too little medicine and you will not get infections but you might have rejection
- Too much medicine and you are less likely to have rejection but you might get lots of infections.
This is why we try really hard to prescribe the right amount of immunosuppression for you and why your blood tests are so important.
Summary
- Rejection happens when your immune system tries to fight off your transplanted heart.
- The medicines you take will help stop rejection from happening.
- Rejection can feel a bit like having flu.
- Rejection can be treated. If you feel unwell, tell your parents or carers immediately so they can talk to us about it.
Who should I contact if I have questions about rejection?
If you have any questions about rejection or if you have concerns about the information in this leaflet, please chat to a member of your transplant team.
Please do not hesitate to talk to a member of staff at your next clinic appointment, or, you can call the children’s transplant nurse specialists on the numbers on page 5.
Outside of these times, please ring Ward 23, Freeman Hospital on 0191 213 7023
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