Rejection 101: What Parents of Teens Should Know
Helping your teen take on their transplant care can feel overwhelming at times—but you’re not alone. Here’s what you need to know about rejection and how you and your teen can work with the transplant team to keep their transplanted organ healthy. Your confidence in understanding their transplant health will help them learn about their care as they take on more responsibility.
How will my teen and I know if they have rejection?
For some types of transplants, rejection shows up in lab work before your teen feels anything at all. That’s why getting labs on time is so important. For others, symptoms may start to occur such as:
- Feeling “off” or more tired than usual
- Fever (around 101°F/38.5°C or higher)
- Flu‑like symptoms
If your teen feels unwell, call your coordinator or doctor. They may ask for labs or want your teen to come in for a clinic appointment.
Different organs have different symptoms or warning signs. Here are the most common ones:
Liver Transplant
- Low‑grade fever, flu-like feeling
- Tiredness
- Stomach discomfort
- Lab monitoring: LFTs (ALT, AST, GGTP, total bilirubin). Higher-than-normal results may signal rejection.
- Later signs: yellowing of skin/eyes, pale stools, dark urine, swollen belly, itching, fluid around the liver (ascites).
Kidney Transplant
- Fever, tiredness
- Low urine output
- Pain over the kidney
- Swelling (edema) or sudden weight gain
- Labs: BUN and creatinine
Heart Transplant
- Fever, chills, aches, headaches
- Sudden weight gain
- Feeling “not quite right”
- New chest pain or shortness of breath
- Fast heartbeat or palpitations
- Low blood pressure
- Swelling in hands/feet/ankles
- Decreased appetite, nausea
Lung Transplant
- Fever, flu-like feeling
- Cough or chest congestion
- Shortness of breath
- New chest pain or tenderness
- Feeling unusually tired
Intestine Transplant
- Fever, flu-like symptoms
- Belly pain or swelling
- Diarrhea or increased stooling
- Bloody stools
- Labs: No specific rejection labs, but electrolytes and albumin may be abnormal.
How does the team confirm rejection?
A biopsy of the transplanted organ is the most accurate way to confirm rejection. A small tissue sample is taken from the organ to check for rejection. Other tests and procedures can also help diagnose rejection including blood tests (like checking liver function tests for liver transplant patients), imaging tests (like a chest X‑ray for lung transplant), or an endoscopy (for intestine transplant).
How is rejection treated?
Most of the time, rejection can be treated. The treatment plan depends on:
- The organ transplanted
- How long it’s been since the transplant
- The degree of rejection (mild, moderate, or severe)
- The type of rejection
- Other conditions or illnesses the patient may have
Depending on these factors, treatment can usually be done in the outpatient setting. The transplant team may:
- Increase your teen’s main anti‑rejection med (tacrolimus, sirolimus, cyclosporine)
- Add or increase prednisone
- Add another anti-rejection medication like mycophenolate or azathioprine
- Monitor labs more frequently
- Schedule extra clinic visits
If rejection is slow to improve, or is more severe, transplant recipients are admitted to the hospital for intravenous (IV) medications, additional tests, and closer monitoring. Treatment may include giving IV steroids (methylprednisolone) and IV antibody therapies (anti-thymocyte globulin, alemtuzumab, basiliximab). A biopsy may be repeated to see how the transplant organ is responding to treatment.
If your teen has rejection, what’s next?
Support your teen in taking on responsibility for their care as they recover from rejection. Encourage them to:
- Take medications every day and on time. This is huge—alarms, apps, and pill organizers can help a lot.
- Stay on top of dose changes.
- Get labs done on schedule. This helps the team ensure the treatment is working.
- Keep in touch with their transplant coordinator to check on dose changes and labs.
- Attend all follow‑up visits.
- Keep your transplant team updated. Tell them how you are feeling, if you are having any side effects from the medications, or have any new symptoms.
Remember—you and your teen are not doing this alone. Your transplant team is here to help your teen engage in their care as they learn more about rejection and to support you as they become more independent.
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