Organ rejection: signs, prevention, and what to do

Organ rejection happens when your immune system treats a transplanted organ as foreign and attacks it. It can be sudden or slow. Catching rejection early makes a big difference, so know the signs, act fast, and keep close contact with your transplant team.

Common signs to watch for

Symptoms vary by organ but some are common. For a kidney: rising creatinine, less urine, swelling, and fatigue. For a liver: jaundice, dark urine, pale stools, or belly pain. For a heart: shortness of breath, new swelling, irregular heartbeat, or low exercise tolerance. For lungs: cough, shortness of breath, fever, or lower oxygen levels. Fever, unexplained fatigue, or sudden changes always warrant a call to your clinic.

Lab changes often show before you feel worse. Pay attention to trends in blood tests your team tracks—creatinine, liver enzymes, drug levels, or biopsy results. Many centers use routine monitoring and donor-specific antibody (DSA) testing to catch problems early.

Practical steps if you suspect rejection

First call your transplant clinic right away. Don’t try to guess at home. They may ask you to come in for labs, imaging, or a biopsy. Quick evaluation guides treatment and improves outcomes.

Treatment depends on type and severity. Acute cellular rejection is often treated with high-dose steroids or anti–T-cell therapies like thymoglobulin. Antibody-mediated rejection may need plasmapheresis, IVIG, rituximab, or other targeted therapies. Your team tailors therapy based on biopsy and antibody tests.

Medication adherence is the single most important thing you control. Missing doses or stopping immunosuppressants raises rejection risk fast. Set alarms, use pillboxes, and refill meds early. If side effects make you want to stop, call your provider—there are usually safer alternatives or dose adjustments.

Watch drug interactions closely. Drugs, supplements, and foods can change levels of tacrolimus, cyclosporine, or mTOR inhibitors. For example, grapefruit and some antibiotics can raise levels dangerously. Ask your pharmacist or transplant nurse before starting anything new.

Prevention also means infection control and vaccinations. Live vaccines are usually avoided after transplant, but flu and pneumococcal shots are important. Plan vaccines with your transplant team and follow timing recommendations.

Lifestyle matters: keep blood pressure, blood sugar, and weight in check; avoid smoking; and practice safe food handling. Regular follow-up visits, lab checks, and communication with your team catch small problems before they become emergencies.

If you travel, carry a list of your meds, contact info for your transplant center, and enough medication to cover delays. Wear medical alert info if possible. Quick access to care can matter in a crisis.

Rejection is scary, but early action and close follow-up help most people keep their transplant working. When in doubt, call your transplant team—early testing and treatment give you the best chance to protect your organ.