What is rejection?

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Rejection occurs when your body's natural defenses, called the immune system, damage the new liver. Your immune system keeps you healthy by fighting against things that don't belong in your body, such as bacteria and viruses. After a transplant, it is common for your immune system to fight against the liver and try to destroy it.

How is rejection prevented?

To keep your body from rejecting the new liver, you will take medicines. These drugs, such as steroids, cyclosporine, tacrolimus, sirolimus, and mycophenolate mofetil, are called immunosuppressants. Immunosuppressants weaken your immune system's ability to reject your new liver.

Do immunosuppressants have any side effects?

Yes. You can get infections more easily because these drugs weaken your immune system. You will need to stay away from people who are sick. These drugs may also increase your blood pressure, cause your cholesterol to rise, cause diabetes, weaken your bones, and damage your kidneys. Steroid drugs may also cause changes in how you look by causing weight gain. Your doctor and the transplant team will monitor these effects and may treat you for complications.

What are the signs of rejection?

Doctors will check your blood for liver enzymes, the first sign of rejection. Often rejection does not make you feel ill. Sometimes rejection can cause

nausea
pain
fever
jaundice

Often, a liver biopsy is needed to be sure that the transplanted liver is being rejected. For a biopsy, the doctor takes a small piece of the liver to view under a microscope.

Blood tests will show if the new liver is being rejected.

What are the other problems that can damage the liver transplant?
Return of the problem that made the transplant necessary in the first place is the most common problem for patients with liver transplants. Also, hepatitis C virus may damage a transplant if the patient was infected before the operation took place.
Other problems include

blockage of the blood vessels going into or out of the liver
damage to the tubes that carry bile into the intestine