• The Immune System and Organ Transplant: What You Should Know

    PD Medicine/Healthcare MHE 091 Thousands of people undergo organ transplant surgery each year and get a second chance to lead healthy lives. While there are risks involved in any surgery, those who undergo an organ transplant also face the possibility that their immune system will reject their new organ and that they will always be at a higher risk for infections. Fortunately, medical research has come a long way and now offers those in need of a new organ an even greater chance of successful recovery.

    How the Immune System Works

    The immune system is a complex biological system in the human body. It is made up of cells, tissues, and organs that work constantly to deal with infectious and other foreign materials, such as allergens or tumors, that may be harmful to the body. These materials carry antigens. The immune system is able to recognize the difference between cells that belong and those that do not by learning to identify protein markers (antigens) that are found on cell and infection surfaces. In people, the antigens or markers that identify your immune system are referred to as the human leukocyte antigen (HLA). Antigens that are recognized as unfriendly invaders stimulate an immune response to destroy them.
    The immune system is made up of several types of white blood cells, also called leukocytes, which each have their own function. White blood cells are made up of:
    Type Function
    Neutrophils Destroy bacteria and fungi
    Eosinophils Destroy larger parasites; also involved in allergy-related inflammatory response
    Basophils Release histamines, which produce an inflammatory response that help fight infection
    Lymphocytes—the main defenders of the immune system B-cells release antibodies, and help activate T-cells

    T-cells attack viruses and tumors
    Monocytes Migrate in bloodstream and help T-cells with recognizing antigens that needs to be destroyed

    The Immune System and Organ Transplant

    Some people may have diseases that lead to organ failure, or they may have suffered an injury that would require an organ transplant. Major organs that may be transplanted include:
    While many organ transplants are successful, there is still a chance that the recipient's immune system will reject the transplanted organ. Before a patient can have an organ transplant, they will take a blood test that will allow doctors to perform tissue typing. This lets doctors check the compatibility between donor and recipient tissues by comparing HLA markers.
    Because everyone’s HLA markers are different, with the exception of identical twins, matches are made as close as possible. Without a close match, the organ will be rejected, and T cells will begin their attack. There are 3 types of organ rejection:
    • Hyperacute rejection—Rare, but can occur within minutes of a transplant.
    • Acute rejection—Can occur a few weeks after a transplant, but the greatest risk is within the first 6 months after the transplant.
    • Chronic rejection—Can occur months after a transplant. The cause is unknown, but it may be linked to non-adherence to antirejection medications

    What to Expect After an Organ Transplant

    Regardless of how well-matched a donor and recipient are, the recipient’s body will still try to reject the new organ since it is made completely of foreign cells. Fortunately, there are ways for patients and doctors to work together to prevent rejection or infection. While treatments and health care will vary depending on the organ transplanted and the patient, most recovery programs will involve similar care.

    Healthcare After Organ Transplant Surgery

    After an organ transplant, patients will continue to work with their healthcare team, who will monitor their recovery. They will also work together to develop medication dosages and lifestyle plans that will keep patients healthy for the rest of their lives.
    Immunosuppressant Drugs
    To prevent rejection, immunosuppressant drugs will be given to decrease the body’s normal immune response. These drugs will need to be taken for the rest of the patient’s life. Since these drugs reduce the immune system’s ability to fight infections, a combination of antiviral, antifungal, and antibiotic medications may also be prescribed.
    Medications may have a number of side effects, such as headache, nausea, and weight gain. They may also cause problems such as high blood pressure or high cholesterol.
    There is also an increased risk of cancer as a result of suppressing the immune system. However, the risk of cancer may vary depending on different factors, such as which medications are chosen, age, or whether there is a family history of cancer.
    Post-transplant Testing
    After an organ transplant, patients will also continue to undergo many tests to ensure that there is no infection and that the organ is not being rejected. Tests vary depending on the specific organ, but can include blood tests, imaging tests like X-rays, or biopsies.
    Diet and Exercise
    While each patient’s circumstances and recovery time will be different, discussing a diet and exercise program with your healthcare team is a wise decision. Patients should learn about creating a balanced diet for themselves, which may also help with other side effects of transplant surgery and medications, such as high cholesterol.
    Exercise, which may be minimal to start, is also recommended to help the body return to a healthy state and may also help with weight gain caused by taking immunosuppressant drugs.

    Additional Health Concerns


    Some women worry about becoming pregnant after an organ transplant. While there are risks involved, particularly during the first year after surgery when the risk of rejection is highest, many women have successfully had children after a transplant. Any plans to get pregnant should be discussed with your healthcare team.

    Substance Use

    Those who plan to receive organ transplants are required to stop smoking or using other drugs and alcohol in order to stay on the waiting list for an organ transplant. After surgery, some may find it hard to avoid old habits. Therefore, it is important for these individuals to find a support system, whether it’s family or a support group, to ensure that they stay healthy.
    With proper care, the body will have a better chance of accepting the new organ, as well as avoiding possible infections after the transplant.


    American Liver Foundation http://www.liverfoundation.org

    National Kidney Foundation https://www.kidney.org


    Canadian Society of Transplantation http://www.cst-transplant.ca

    Public Health Agency of Canada http://www.phac-aspc.gc.ca


    Explore heart transplant. National Heart, Lung, and Blood institute website. Available at: https://www.nhlbi.nih.gov/health/health-topics/topics/ht. Updated December 9, 2016. Accessed July 27, 2017.

    Kidney transplantation: Past, present and future: What is chronic rejection? What is being done about it? Stanford University website. Available at: http://web.stanford.edu/dept/HPS/transplant/html/chronic.html. Accessed July 27, 2017.

    Prevention of cytomegalovirus infection in solid-organ transplant recipients. DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T910475/Prevention-of-cytomegalovirus-infection-in-solid-organ-transplant-recipients#Posttransplantation-prevention. Updated June 30, 2016. Accessed July 27, 2017.

    Understanding the immune system: how it works. Immuno Genetics website. Available at: http://www.imgt.org/IMGTeducation/Tutorials/ImmuneSystem/UK/the%5Fimmune%5Fsystem.pdf. Accessed July 27, 2017.

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