On this page
- What is rejection?
- Are there different types of rejection?
- What does rejection feel like?
- What tests might the transplant doctors need to do?
- Can rejection be treated?
- How can I help stop rejection happening?
- Can rejection happen even if I take my medicines?
- Who should I contact if I have questions about rejection?
- Resources
- Further information
- Useful websites
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. Rejection can happen to anyone who has had a transplant.
The immune system is very powerful and complicated and is made up of many special 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.
Are there different types of rejection?
Yes, there are three different types of rejection.
What does rejection feel like?
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. 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
- Unexplained reduction in how much exercise you can do
- Flu-like symptoms
- Feeling breathless or having difficulty breathing
- Palpitations or feeling your heartbeat is faster or more irregular than normal
- Mild fever
- Reduction in your lung function readings of 10% or more
- Cough and/or increased sputum production
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.
What tests might the transplant doctors need to do?
The common tests you may need include
- Physical examination and to ask you about your symptoms
- Blood tests to look for signs of infection or to find out whether there are any antibodies in your bloodstream
- Lung function tests to check for a decline in the function
- A chest X-ray (CXR) to look for changes in your lungs or signs of infection
- A CT scan to look for abnormal changes in your lungs
- A bronchoscopy may be needed, this is a procedure where the doctors look at your airways, it allows small samples (biopsy) to be taken which are checked under a microscope in the laboratory to look for rejection or for samples to be taken to look for germs; this is called a bronchoalveolar lavage (BAL). A biopsy may be needed to check whether you have rejection or to confirm that rejection has been successfully treated. Most children have this done whilst asleep under general anaesthetic, but most adults have it done with sedation.
Can rejection be treated?
Acute rejection can be treated, and it is 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, and they can speak to your transplant team.
Powerful medicines are available to treat rejection and usually they work quickly. In antibody mediated rejection we sometimes use a treatment to wash the antibodies out of your bloodstream then give medicines to try to stop them coming back. Most children soon feel better once they are treated.
Chronic rejection or OB cannot be cured but can be treated and controlled. Treatment can be difficult but there are several treatments which may be considered.
- Alternate or additional immunosuppressive medications may slow down the process.
- Total Lymphoid Irradiation (TLI) is a form of high-energy x-ray treatment which cause a biological effect to reduce the number of white blood cells and make the immune system less effective.
- Extra Corporeal Photophoresis (ECP) is a form of treatment that is sometimes used, it involves a dialysis-type central line and blood is then treated and returned to the body, a bit like someone having dialysis
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 lungs.
- The most common medicines used are ciclosporin, tacrolimus, mycophenolate mofetil (MMF), mycophenolic acid, azathioprine, prednisolone, and sirolimus.
- You will be taking at least one of these medicines and you may be on more than one.
- If you 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
- Don’t skip doses or take them late as this will affect the amount of medicine in your blood stream
- Illnesses such as diarrhoea and vomiting can affect the amount of medicine your body absorbs. If you’re unwell, we need to know in case we need to adapt your medications to prevent rejection happening.
- Some medicines including over the counter medicines and herbal remedies, can also affect the amount of immunosuppression in your body. Please always check with us before you start taking something new.
- Grapefruit also affects your immunosuppression levels, and you shouldn’t eat or drink anything which contains grapefruit
Can rejection happen even if I take my medicines?
Rejection is less likely to develop if you take the correct amount of your medicines at the right times. It can still happen though, which is why you need to know what rejection might feel like and you should 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 get fewer infections, but you might develop rejection; too much medicine and you are less likely to develop 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 lungs.
- The medicines you take will help stop rejection from happening.
- Rejection can feel a bit like having flu.
- Acute rejection can be treated. If you feel unwell tell your parents or carers straight away so they can talk to us about it immediately.
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 don’t 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 at the end of this leaflet.
If you have symptoms of rejection, please contact us urgently or attend your local emergency department.
Resources
Contact
For further information, contact the transplant nurse specialists.
Office hours: Monday to Friday, 9am to 5pm
Contact out-of-hours
Outside of these times please ring ward 23 if you have an urgent query affecting your child’s transplant health.
Further information
PALS (Patient Advice and Liaison Service) for help, advice, and information about NHS services. You can contact them on Freephone 0800 032 02 02, email [email protected]
Useful websites
If you would like further information about health conditions and treatment options, you may wish to have a look at the NHS website at www.nhs.uk
If you would like to find accessibility information for our hospitals, please visit http://www.accessable.co.uk