Liver transplant rejection occurs when your immune system attacks your transplanted liver, causing damage to the organ. It usually happens when your immune system detects proteins called antigens on your transplanted liver that aren’t from your body. Because these proteins are “foreign,” your immune system will try to destroy them — just as it would try to destroy other foreign substances such as germs or cancer cells.
At UPMC, our organ transplant experts work to reduce the risk of liver transplant rejection through advanced organ matching methods and provide comprehensive, lifelong follow-up care after your transplant. By detecting signs of rejection early, our team can take action to protect your organ and develop a plan for your ongoing care.
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Liver transplant rejection occurs when your immune system attacks your transplanted liver, causing damage to the organ. This condition usually happens when your immune system detects proteins called antigens on your transplanted liver that aren’t from your body. Since these proteins are “foreign,” your immune system will try to destroy them — just as it would try to destroy other foreign substances such as germs or cancer cells.
There are three types of liver transplant rejection, including:
Acute rejection is the most common type of liver transplant rejection, with some level of rejection occurring in nearly all transplant recipients within the first year after their transplant. Acute rejection is typically treated with medications.
Chronic rejection is less common than acute rejection, affecting 2% to 10% of liver transplant recipients. Hyperacute rejection is very rare, affecting less than 1% of liver transplant recipients.
When you receive an organ transplant, the antigens on your transplanted organ are slightly different from the antigens found in the rest of your body. Your highly sensitive immune system can detect that these antigens are “foreign,” and tries to protect you by attacking and damaging your transplanted organ — in the same way your immune system may try to protect you by reacting to and destroying other substances, such as germs, cancer cells, or allergens.
You may be at a higher risk of liver transplant rejection if the antigens on your donor organ are not a close enough match to the antigens in your body. Although most matches are not perfect — only identical twins have identical antigens — advanced tissue typing techniques can reduce the risk of organ rejection.
You may also be at a higher risk of liver transplant rejection if you do not take your immunosuppressant medications after your transplant.
Complications of liver transplant rejection and treatment may include:
You can reduce your risk of liver transplant rejection by taking all immunosuppressant medications as prescribed, going to all follow-up appointments, and letting your transplant team know if you have any symptoms of transplant rejection.
You can also maintain a healthy lifestyle by:
The most common symptoms of liver transplant rejection are yellowing of your skin or the whites of your eyes, and easy bleeding or bruising.
What happens when a liver transplant is rejected depends on how soon after the transplant the rejection occurs, the symptoms, and other factors. If you show symptoms of liver transplant rejection, your doctor will create a treatment plan to manage your condition.
If you notice symptoms of liver transplant rejection, you should schedule an appointment with your transplant doctor as soon as possible.
Your doctor will perform a physical exam and order tests to help diagnose liver transplant rejection.
If your doctor suspects liver transplant rejection, they will:
Tests to diagnose liver transplant rejection may include:
Blood tests to diagnose liver transplant rejection may include:
Imaging tests to diagnose liver transplant rejection may include:
A liver biopsy is a procedure that involves using a thin needle to remove tissue samples from your liver. The tissue samples are examined in the lab for signs of liver transplant rejection.
People who have a liver transplant need to take immunosuppressant medications for the rest of their lives. Acute rejection can often be managed with medication. However, chronic rejection may lead to liver failure and require another liver transplant.
Most people can expect to live for years after a liver transplant. Research shows the one-year survival rate after liver transplant is between 85% to 90%, and the five-year survival rate is 70% to 75%.
Liver transplant rejection is treated differently depending on the cause.
After your transplant, your doctor will prescribe medications to suppress your immune system and prevent it from attacking your new organ. If you experience symptoms of acute rejection, your doctor may adjust the dosages of your medication to stop the rejection.
Chronic rejection happens slowly over time and is less likely to be treatable with medications. If you experience symptoms of chronic rejection, your doctor may start by adjusting the dosages of your medication and taking steps to manage symptoms. They may also evaluate you for another transplant.
When you choose UPMC for liver transplant rejection care, you will receive:
By UPMC Editorial Staff. Last reviewed on 2025-12-09.
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