Kidney transplant rejection

Kidney transplant rejection

What happens when the body rejects a kidney transplant?

What is the average life expectancy after a kidney transplant?
What is Rejection?

Rejection is a normal reaction of the body to a foreign object. When a new kidney is placed in a person's body, the body sees the transplanted organ as a threat and tries to attack it. The immune system makes antibodies to try to kill the new organ, not realizing that the transplanted kidney is beneficial. Although rejection is most common in the first six months after surgery, it can occur at any time.

To allow the organ to successfully live in a new body, medications must be given to trick the immune system into accepting the transplant and not thinking it is a foreign object.

Other factors that may contribute to the failure of a kidney transplant include:

. A blood clot that limits blood flow to the kidney shortly after surgery

. Fluid collection and pressure build up around the kidney

. Infection in the kidney that causes problems in kidney function

. Issues with donor kidney

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What are the signs and symptoms of kidney rejection?

How do I know I am rejecting my kidney?

When you receive regular kidney-function tests, the patterns of the results will help your doctor observe what is happening to your transplanted kidney. If your blood test results are out of the normal range, your transplant physician or transplant coordinator will discuss the results with you. Some abnormal lab values may be acceptable as you recover from transplant or a related complication and should improve over time.

After you leave the hospital, your blood tests will be monitored less frequently. If rejection occurs, you may experience some mild symptoms, although some patients may continue to feel fine for a while. The most common early symptoms include:

. Fever greater than 100°

. Increased kidney function tests

. Decreased urine output

. Tenderness over the graft

. Swelling of hands, eyelids, or lower extremities

. "Flu-like" symptoms: chills, aches, headache, dizziness, nausea and/or vomiting

. Weight gain of 2–4 lbs (1-2 kgs) in 24 hours

. Elevated blood creatinine level

. High blood pressure

Additionally, your doctor may want you to have a kidney biopsy to confirm that your symptoms are caused by rejection.

Your transplant team will instruct you on who to call immediately if any of these symptoms occur.

Types of Kidney Rejection

There are several types of kidney rejection. These types are described by the kind of cells causing the rejection, when the rejection occurs, and by the severity of the rejection.

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. Hyperacute rejection: Occurs within minutes of the kidney transplant, when the recipient's antibodies immediately recognize the kidney as foreign and attack it. Hyperacute rejection usually cannot be treated and results in the loss of the kidney. A special test called a crossmatch is completed before kidney transplant to identify antibodies that could cause hyperacute rejection.

. Accelerated acute rejection: Occurs within the first three to seven days after transplantation. This form of rejection is difficult to treat, but there have been recent improvements in treatments for this type of rejection. Patients with high antibody levels (high PRA) are at higher risk for developing accelerated acute rejection.

. Acute cellular rejection: This is the most common form of rejection and can happen at any time. About 15–25% of kidney transplant recipients have at least one mild to moderate episode of acute rejection within the first three months after transplant. Acute rejection can be treated, and having acute rejection does not mean that you will lose your transplanted kidney, but it is extremely important that rejection is diagnosed and treated as soon as possible.

. Chronic rejection: This happens if the rejection process does not completely resolve, or if it continues slowly over time. It is more difficult to treat because of more permanent changes in the kidney tissue, and eventually the kidney will lose all function.

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How is rejection identified?

The transplant team will be able to determine if kidney rejection is present by performing scheduled protocol kidney biopsies at approximately three to six months and at one year post-transplant as a diagnostic screening tool, or if you are experiencing any of the warning signs and symptoms of rejection. If the transplant team thinks that you may be having problems with your kidney, the following tests may be ordered:

. Repeated blood work

. Renal ultrasound to check blood flow to the kidney

. Kidney biopsy

What is done to prevent rejection?

Medications must be given for the rest of your life to fight rejection. Each person is individual, and each transplant team has preferences for different medications. The anti-rejection medications most commonly used include:

. Cyclosporine

. Tacrolimus

. Azathioprine

. Mycophenolate mofetil

. Prednisone      

. Okt3

. Antithymocyte ig (atgam)

New anti-rejection medications are continually being approved. Physicians tailor drug regimes to meet the needs of each individual patient. Usually several anti-rejection medications are given initially. The doses of these medications may change frequently as your response to them changes. Because anti-rejection medications affect the immune system, persons who receive a transplant will be at higher risk for infections.

A balance must be maintained between preventing rejection and making you very susceptible to infection. Blood tests to measure the amount of medication in the body are done periodically to make sure you do not get too much or too little of the medications. White blood cells are also an important indicator of how much medication you need.

This risk of infection is especially great in the first few months because higher doses of anti-rejection medications are given during this time. You will most likely need to take medications to prevent other infections from occurring.

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Call your transplant coordinator if:

. You are unable to take your medications because you are vomiting or have diarrhea and are worried that you are not absorbing your medications.

. You have forgotten to take your medication or missed any doses due to illness.

. The directions on the medication label from the pharmacy are different than what you were told.

. You feel you are having an unusual reaction or side effects to a medication.

. You would like to take over-the-counter medications, such Tylenol (acetaminophen) for fever.

. You are instructed to take any new medications by your local doctor or if any changes are made to your current medications by another doctor.

What is a kidney biopsy?

A kidney biopsy is a procedure that involves taking a small sample of kidney tissue from the transplanted kidney so that it can be tested to see if rejection is present. A kidney biopsy can be performed by an interventional radiologist or by a transplant team physician in an outpatient setting or in the hospital.

In order to take a biopsy, the skin above your kidney is numbed with medication and a small nick is made in the skin to allow a small needle to pass through to your kidney. Several kidney tissue samples will be collected. The tissue samples are examined under a microscope to establish a diagnosis. The biopsy procedure generally takes between 20 and 30 minutes. You are required to lie flat for two hours following the procedure to prevent bleeding.

Kidney transplant success rate

The success rate for a kidney transplant is relatively high and there are only a small number of kidney transplant rejections.

. 97% of kidney transplants are working a month after the procedure

. 93% of kidney transplants are working a year after the procedure

. 83% of kidney transplants are working 3 years after the procedure

. 54% of kidney transplants are working 10 years after the procedure

Re-Transplantation

Approximately 20% of all kidney transplants are re-transplantations for patients who have previously had a kidney transplant.

Many patients begin the process of finding potential donors and getting on the waiting list as their kidney is failing and before they restart dialysis. This can help them to feel more in control of the process and their health.

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10 common questions about kidney transplant rejection

1What happens if you reject a kidney transplant?
Less than 1 in 20 transplant patients have an acute rejection episode that leads to complete failure of their new kidney. Chronic rejection happens more often and occurs slowly over the years after your kidney transplant. Over time, your new kidney may stop working because your immune system will constantly fight it.
2Can you reverse kidney transplant rejection?
To date, there is no medication used to reverse this type of rejection. Kidney function generally lasts for months or even years after the diagnosis is made. If the kidney transplant is rejected, you may be able to receive another transplant in the future. Sometimes the transplanted kidney must be surgically removed
3What causes kidney rejection after transplant?
Acute rejection can be caused by white blood cells attacking the kidney ('cellular' or 'T cell mediated rejection'), or it may be caused by antibodies against the kidney. Antibody mediated rejection often requires stronger treatment. It is not common to loose a kidney from acute rejection it can be treated.
4Can a person live normal life after kidney transplant?
People can live normal lives with only one kidney. As long as the donor is evaluated thoroughly and cleared for donation, he or she can lead a normal life after the surgery. When the kidney is removed, the single normal kidney will increase in size to compensate for the loss of the donated kidney
5What is cellular rejection in kidney transplant?
Tubulitis occurs when the lymphocytes and monocytes extend into the walls and lumina of the tubules. Presence of leukocytes determines infection or antibody-mediated rejection. ... Treatment of acute cellular rejection in kidney transplant recipients include pulse steroid for the first rejection episode
6Is 1.6 creatinine level OK in transplant patient?
If the potential recipient of the kidney transplant has a serum creatinine of 1.6 milligrams per deciliter (mg/dl) then a kidney transplant is not needed. If the potential donor has a serum creatinine of 1.6 and is a live donor, this should not be done
7What helps edema after kidney transplant?
Treatment for fluid buildup and edema aims to reduce the amount of protein that is filtered out of the blood and into the urine in order to relieve fluid retention and subsequent swelling. This can be done by restricting salt in the diet and through medications called diuretics
8What are the disadvantages of kidney transplant?
A successful kidney transplant can improve your quality of life and reduce your risk of dying. ... Disadvantages — Kidney transplantation is a major surgical procedure that has risks both during and after the surgery. The risks of the surgery include infection, bleeding, and damage to the surrounding organs
9Does kidney transplant last forever?
A transplanted kidney's lifespan is 15 to 20 years on average. If the kidney stops working, the patient is back on the waiting list for a new one. However, a second or even a third transplant is more complex, as finding a new good match between donor and recipient becomes increasingly difficult
10What is the longest lasting kidney transplant?
Karen is the longest living kidney recipient in the UW Health Transplant Program

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