Transplant Rejection

Recognising rejection

Rejection does not always cause obvious symptoms, which is why transplant teams schedule regular biopsies and blood tests. When symptoms do appear they vary by organ: a kidney rejection may cause reduced urine output, swelling, and tenderness over the graft site; a liver rejection can present as jaundice and elevated liver enzymes; a heart recipient may notice breathlessness or fatigue. Fever and a general feeling of illness are common across organ types. Any sudden change in how you feel after a transplant warrants prompt contact with your transplant team.

Keeping the immune system in check

Prevention is the foundation of transplant care. Medicines from the autoimmune support class are used in combination to suppress the immune response without disabling it entirely. Tacrolimus and ciclosporin target calcineurin, a protein central to the immune cascade. Mycophenolate mofetil and azathioprine reduce the production of immune cells that attack the graft. Sirolimus works through a different pathway and is often used when calcineurin inhibitors are not well tolerated.

Most recipients take two or three of these agents together at the lowest dose that keeps the organ stable, balancing rejection risk against infection risk. Doses are reviewed frequently, particularly in the first year and after any rejection episode.

Transplant care across Asia

Organ transplant programmes are well established in Singapore, South Korea, Japan, Taiwan, and India, with growing capacity in Thailand and Malaysia. Living-donor kidney transplants are especially common across South and Southeast Asia given the limited availability of deceased-donor organs. Wherever surgery takes place, lifelong immunosuppression and specialist follow-up are essential components of care.