Life After an Organ Transplant

How a transplanted organ is protected

Your immune system recognizes the new organ as foreign because the donor's tissue markers (HLA proteins) differ from yours. Without treatment, it would destroy the organ within days to weeks. Anti-rejection medicines damp down this response. The exception is a transplant between identical twins.

The transplant process itself, from evaluation and the waiting list to matching and surgery, is covered on the organ transplantation page. This page explains what comes after.

Anti-rejection medicines

Most people take two or three of these. Doses are adjusted using regular blood levels, especially in the first year.

Rules that protect the organ:

• Take every dose on time, every day. Use alarms and a pill organizer.
• Never stop or change a dose without your team.
• Avoid grapefruit, pomelo and Seville orange, which raise tacrolimus and cyclosporine levels.
• Check every new medicine, herbal product or supplement with your pharmacist. St John's wort lowers levels and can trigger rejection. Some antibiotics and antifungals raise levels to toxic ranges.
• Avoid NSAIDs such as ibuprofen after a kidney transplant unless your team agrees.

Signs of rejection

Early rejection usually causes no symptoms, which is why scheduled blood tests matter. When symptoms occur, they depend on the organ:

• Kidney: rising creatinine, less urine, weight gain from fluid, swelling, tenderness over the transplant (usually in the lower belly), high blood pressure.
• Liver: yellow skin or eyes, dark urine, pale stools, itching, abnormal liver tests.
• Heart: breathlessness, tiredness, swelling, palpitations. Routine heart biopsies or blood tests check for silent rejection.
• Lung: cough, breathlessness, fever, a drop in home spirometry readings.
• Pancreas: rising blood sugar, belly pain.

Rejection is confirmed with a biopsy of the organ in most cases. Not taking medicines as prescribed is one of the most common causes of late rejection.

Infection risk

Immunosuppression makes infections more common and sometimes harder to recognize, since fever and other signs may be muted.

• First month: surgical wound, urinary, line and pneumonia infections.
• Months 1 to 6: opportunistic infections such as cytomegalovirus (CMV), BK virus (kidney), pneumocystis pneumonia and fungal infections. Preventive antivirals and antibiotics are usually given during this time.
• Later: common community infections, plus reactivation of shingles and other viruses.

Protect yourself:

• Wash hands often and avoid close contact with sick people.
• Get recommended inactivated vaccines (flu, COVID-19, pneumococcal, recombinant shingles). Avoid live vaccines such as MMR, chickenpox and yellow fever after transplant.
• Food safety: avoid raw or undercooked meat, eggs and seafood, unpasteurized dairy and unwashed produce.
• Wear gloves for gardening, and avoid cleaning litter boxes and bird cages.

Other long-term health issues

• Skin cancer: squamous cell carcinoma is many times more common than in the general population. Use sun protection daily and have a skin check at least yearly. See skin cancer.
• Post-transplant lymphoproliferative disorder (PTLD): a lymphoma linked to Epstein-Barr virus. Swollen glands, fevers, night sweats and weight loss need checking.
• Kidney damage from calcineurin inhibitors, including after heart, lung and liver transplants.
• Diabetes after transplant, high blood pressure and high cholesterol, which raise heart risk.
• Bone thinning from steroids.
• Graft-versus-host disease: rare after solid organ transplants (more after liver and intestine), where donor immune cells attack the recipient. See graft-versus-host disease.

Living well after a transplant

• Follow-up: frequent clinic visits and blood tests in the first months, then every 1 to 3 months long term.
• Activity: most people return to work and normal activity within 2 to 6 months.
• Diet: a heart-healthy diet with limited salt; weight gain is common after transplant.
• Pregnancy: possible for many recipients, usually after at least 1 year of stable function, with planning because some drugs (mycophenolate) harm a developing baby.
• Emotional health: anxiety, guilt toward the donor and depression are common and treatable.

How long transplanted organs last

Survival depends on the organ, donor type, age and adherence. Kidneys from living donors last longest on average, often 15 to 20 years; deceased-donor kidneys average around 10 to 15 years. Most liver and heart transplant recipients are alive at 5 years, and many live well for decades. Lung transplants have the shortest average survival, mainly because of chronic rejection. A failing organ can sometimes be replaced with a second transplant.

Frequently asked questions

What are the first signs of organ rejection?

Often there are none, which is why regular blood tests are essential. When symptoms appear they may include fever, fatigue, pain or tenderness over the transplant, swelling, reduced urine (kidney), yellow skin or dark urine (liver), or breathlessness (heart or lung). Call your transplant team promptly about any of these.

Do you have to take anti-rejection drugs for life?

Yes, in almost all cases. Even years after a transplant, stopping anti-rejection medicines can cause rejection and loss of the organ. Doses are usually lower after the first year. The only common exception is a transplant between identical twins.

Can transplanted organs be rejected years later?

Yes. Acute rejection is most common in the first 6 months, but it can happen at any time, especially if doses are missed or medicine levels drop because of interactions or diarrhea. Chronic rejection develops slowly over years and is the main reason transplanted organs eventually fail.

Why are transplant patients more likely to get infections?

Anti-rejection medicines suppress the immune system, which protects the new organ but also weakens defenses against viruses, bacteria and fungi. Risk is highest in the first 6 months. Preventive medicines, vaccines, hand hygiene and food safety reduce the risk.

What foods should transplant patients avoid?

Avoid grapefruit, pomelo and Seville orange, which interact with tacrolimus and cyclosporine. Also avoid raw or undercooked meat, fish and eggs, unpasteurized milk and cheese, raw sprouts and unwashed produce, which can carry infections. Limit salt and sugar to control blood pressure and diabetes risk.