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What is rejection?

What is rejection?

After transplant, one of the words that gets thrown around a lot and causes a lot of panic is 'rejection'. Because your new organ is in fact not yours the body sees it as a 'foreign object'. The antigens on the new organ are different to what the body recognises and this is why during transplant assessment they test your blood for your personal antigens and they try and match them as closely as they can to your donor organ, the closer they are the lower the risk of rejection. So you're not just matched based on blood type, it's a lot more complex than that.

However, no matter how close the match, rejection of some scale is almost certain to happen in the first 6 months after transplant, although it is usually treatable (or often doesn't even need treatment) because it is caught early through frequent biopsies. Biopsies test for rejection at a cellular level before damage is done to the organ, there are 4 levels used to describe rejection, I've had 1R a few times and they've said it's fine because there's no cell damage just signs of really mild rejection so they do nothing or sometimes would tweak your drugs if your levels were too low, a 2R or 3R you may be admitted to hospital for a course of high dose IV steroids. Chronic rejection is when the body has spotted the foreign organ and has started to attack it, this causes damage to the organ which is irreversible and causes heart failure again, it can be fatal and sometimes a second transplant is required.

To try and prevent the body from recognising the foreign organ transplant patients take several antirejection drugs, also known as immunosupressents.

Anti rejection drugs

Different hospitals use different combinations of drugs for different patients so I can only comment on what I personally take. Anti rejection drugs work by reducing the bodies immune system so that it doesn't easily recognise the foreign organ, this also means that it is weak when it comes to fighting off infections. So similar to pregnant women I cannot eat high risk foods because I'm at risk of food poisoning, I have to be really strict with hand hygiene (especially before I eat and cook) and for the first 3 months you should avoid crowded places. I will also need to avoid people that have infections, like chest infections, chicken pox etc. I will be 'immunosuppressed' for life, if I stopped taking my medication my body would quickly realise that my new heart isn't supposed to be in me. I get quite emotional whenever I get rejection at a biopsy, it's silly but it upsets me that my body is trying to get rid of it when it's actually much better than the old one! Haha. Also it reminds me that it's not really mine and it originally belonged to someone else.

The drugs I take: 

Some people get certain side effects and others don't, some are worse than others in different people too. It's important that the hospital know about your side effects , especially if they're really bothering you because it's so important that you take your drugs.

Prograf (Tacrolimus)

Probably my main anti-rejection, similar to drugs like chemotherapy it's incredibly toxic so if the levels in my blood are too high I get incredibly sick and that's what made me so ill in hospital while my body got used to it. It makes my hair fall out which is really sad, it's been coming out in clumps recently in the shower because my dose has been increased. It also makes people have tremors, thankfully mine aren't too bad anymore, they sometimes get worse if I'm tired or I need to eat.

CellCept (Mycophenolate acid)

This is another antirejection. It works similarly to Prograf by interfering with your attacker cells and weakening your immune system. I'm not sure of any side effects that are specific to this drug as my Prograf and steroid ones are the most obvious. You cannot get pregnant whilst taking CellCept. Even if you are a man, you carry it in your sperm and it affects your baby. There is a 50% chance of miscarriage whilst taking it and a very high chance of serious deformities in your baby, so it's important that the hospital know if you plan on having children so they can swap this to something else and it takes about 3 months to fully leave your body.

Steroids (Prednisolone)

Prednisolone is probably my least favourite drug. You get an IV of it whilst in surgery to completely wipe out your immune system, then I was on 15mg, then 12.5, then 10, 7.5 and I'm currently on 5mg. The hospital I'm at aim to get this drug down to a small dose most importantly because it has the worst side effects. It is important to note that like the others it is not the same for everyone but I have gained weight, it increases your appetite but even though I watch what I eat I believe it also makes you store fat as well as it affects your muscle gain. It especially makes me gain weight on my stomach and face (it causes what's called a moon face), this is because it increases a hormone called cortisol and that makes you store fat in your face and stomach. This is especially hard because I've never stored fat on my stomach so it makes me feel huge even though I haven't actually gained much weight, and in photos where you can only see my face it looks like I've gained loads of weight. 

Prednisolone can also cause acne, I personally already had oily skin but it has made it a lot worse! I have always had a strict skincare routine so I have managed to only get a few spots but it is more than before. I get massive withdrawal every time my prednisolone is reduced, I am exhausted, I get headaches, and often nausea. It wipes me out for a few days really whenever my dose is decreased which is why it is reduced so slowly, some people stay on a small dose forever and some people get taken off it completely. (Here's pics of my face before and after steroids and I'm only on 7.5mg in the second pic, it was puffier than that)




The rest of the medications that I take are to counteract side effects from these three drugs really, I have a stomach liner to protect me from ulcers from the acid. Alendronic acid to prevent osteoporosis from the steroids, statins to protect from coronary artery disease and to lower my cholesterol from the CellCept. And then a lot of the drugs in hospital are to prevent injections while your immune system is so weak such as antivirals, antifungals and antibiotics.

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