Rejection of a liver after transplant occurs because the recipient's cells recognize the donor's cells as foreign and attack the new liver. Immunosuppressant medications are given after transplant to keep the immune system from attacking the new organ's cells, but rejection may still occur. Up to 75 percent of all liver transplant recipients experience at least one bout with rejection, usually within the first two months after transplant, according to the University of Southern California's transplant program.
Elevated Liver Enzymes
A rise in liver enzymes is often the first sign of rejection, according to the National Digestive Diseases Information Clearinghouse (NDDIC). Blood tests done to evaluate the condition of the liver include aspartate aminotransferase (AST), alkaline phosphatase (ALP) and Gamma-glutamyl transferase (GGGT). Liver enzymes can be elevated for reasons besides rejection.
Elevated Bilirubin
Damage to the bile ducts of the liver from infiltration by white blood cells due to rejection can cause elevated levels of bilirubin. Elevated levels of bilirubin may be detected by blood tests, but signs noticed by the patient include light or clay-colored stools, dark or tea-colored urine, itching of the skin and a yellowish tinge to the skin and whites of the eyes, according to the Merck Manual.
Abdominal Symptoms
Abdominal pain, tenderness around the liver or swelling can be signs of liver rejection, according to the Merck Manual. Fluid accumulation called ascites may also occur in the abdomen.
Liver Biopsy
A liver biopsy is the best way to diagnose rejection after liver transplant, according to the Merck Manual. A biopsy of a liver in rejection will show cellular changes that indicate the immune system is attacking the new liver cells.
