Kidney Transplant Rejection

Kidney transplant rejection is a common problem for kidney recipients. Although it sounds scary or serious, doctors usually just have to adjust your medications to make them work better. This usually solves the problem, but you still need to take this seriously to be able to preserve the function of your new organ.

What Is Kidney Transplant Rejection?

The immune system knows when a foreign substance is in your body, and having someone else's kidney in place of your own usually signals the body to react to it. This is the body's natural way of protecting you from harmful substances such as bacteria, poison, cancer cells or foreign tissues. The body's immune system produces proteins (antibodies) to coat the antigens (foreign substances) and then attacks them, resulting in your case: organ rejection or kidney transplant rejection. This often occurs when there is a mismatch in your blood or tissues with the donor's blood or tissues.

There are different types of organ rejection:

  • ŸHyperacute rejection, which occurs within just minutes or a few hours. An example of this reaction happens after transfusion of mismatched blood type. It usually happens because of the presence of pre-existing antibodies in your blood, which causes activation of complement, intravascular injury, platelet adhesion and blood clots (thrombosis).
  • ŸAcute rejection, which occurs over a period of a few days. It usually involves a cell-mediated reaction that leads to destruction of the graft and is often associated with white blood cell infiltrates. It results in cell lysis mediated by killer cells, which leads to organ rejection. Antibodies can also be formed and a reaction leading to inflammation and death of endothelial cells in the blood vessels can occur.
  • ŸChronic rejection, which occurs after several weeks to months, is characterized by fibrosis (the body's attempt to repair damage) and arteriosclerosis that is the main cause of late kidney transplant rejection.

How Do I Know I Am Rejecting the Kidney?

Your doctor needs to evaluate your kidney function by doing tests regularly. The pattern of your test results can help the doctor determine what is happening to your new kidney. Lab tests can measure the amount of waste product in your blood (serum creatinine) that should be normally removed by the kidneys. If your serum creatinine level is rising, then transplant rejection may be happening. You will have frequent clinic visits in the first few months following your transplant to monitor your creatinine levels.

Signs and symptoms of kidney transplant rejection include:

  • Body temperature > 100 °F
  • Pain/tenderness around the transplant
  • Swelling of your hands, feet or eyelids
  • Rapid weight gain
  • Reduced urine output
  • Flu-like symptoms

Confirmation of rejection may be established after doing a kidney biopsy.

How to Deal with Kidney Transplant Rejection

The treatment for hyperacute rejection, which is often severe and occurs within minutes, is immediate. It involves total removal of the foreign tissue. However, for chronic rejection, which responds poorly to treatment and is considered irreversible, only re-transplant can be helpful. Investigation on the use of inhaled cyclosporine is also being done to prevent or delay chronic rejection in lung transplants.

For acute kidney transplant rejection, a few treatment strategies may be done:

1.  Medication

Some immune-suppressing drugs can be helpful, such as

  • ŸCyclosporine, which interferes with T cell communication in the immune system. Treatment starts immediately after the kidney transplant to overpower the immune system and it is indefinitely continued.
  • ŸCorticosteroids, which also block T cell communication. They are often given at high doses immediately after the kidney transplant, and then the dose will be, reduced. Doses are increased if rejection later occurs.
  • ŸAzathioprine, which slows the production of T cells. It is typically used for maintenance of long-term immunosuppression.
  • ŸOther newer drugs include sirolimus, tacrolimus and mizoribine , which all decrease the response of the immune system to the new kidney.

2.  Blood Transfusions

These are sometimes given to patients who do not respond to antibody or immunosuppressive therapy by removing antibody molecules that are specific to the transplanted kidney.

3.  Bone Marrow Transplant

This is done to replace your immune system with the donor's bone marrow so that your system can accept the new kidney without rejection. The bone marrow's stem cells must come from the donor or from an identical twin. However, there is also a risk of rejection of the bone marrow.

How to Decrease the Risks for Kidney Transplant Rejection

To decrease your risk of kidney transplant rejection:

  • Learn more about the signs and symptoms of kidney transplant rejection.
  • Follow your prescriptions about taking medications.
  • Always have enough supply of your medications.
  • Always be in touch with your transplant team/coordinator for any changes in immunosuppression.
  • Have regular blood tests done as recommended.
  • Follow-up with transplant coordinator on blood test results.
  • Call your doctor/transplant coordinator if you are experiencing any symptoms of transplant rejection.
  • Avoid using excessive alcohol, recreational/ illegal drugs and any herbal remedies or supplements
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