Kidney transplant rejection

Rejection is the body's natural way of trying to fight off the new kidney which it considers as "foreign" tissue. Because the body continues to try to reject foreign tissue, you will need to take immunosuppressant medications for the life of the transplanted kidney to help prevent this from happening. The best way to minimize the risk of rejection is for your child to take all of his or her medications each day. Even with these medications almost everyone will have an episode of rejection at some time. The signs of rejection may not always be obvious to you, so it is very important that you maintain records of vital signs, keep all clinic appointments, and have your child’s blood work performed as scheduled.

Signs and symptoms of rejection

Listed below are some of the signs and symptoms of rejection that you may notice. If you experience any of these symptoms, call the renal transplant coordinator immediately.

• Temperature above 100 degrees F
• Decreased urine output (for infants, count the number of wet diapers)
• High blood pressure
• Pain, swelling or tenderness over the new kidney
• General feeling of fatigue, muscle aches, loss of appetite (flu-like symptoms)
• Large weight gain or puffiness
• Increase in blood creatinine level

It is important to note that many rejection episodes result in minimal or no symptoms at all. In these instances, only an increase in the blood creatinine level can suggest to your doctor that there is a problem.

Diagnosing rejection

Rejection is most often diagnosed on the basis of lab work and symptoms, but sometimes other tests are needed to help in the diagnosis. These include:

Renal ultrasound (sonogram)

• Renal scan
• Biopsy
• Glofil

Kidney biopsy

• Your child will be admitted to the hospital and an IV will be placed in his or her arm. Blood tests will be performed prior to the biopsy to assess clotting function.
• Your child cannot have food or drink after midnight before the biopsy. Medications may be given with a small amount of water on the morning of the biopsy.
• Medication is given to make your child sleepy and relaxed before the test is performed.
• The biopsy is performed in the x-ray department with the ultrasound machine.
• Your child will be given medicine to let him or her sleep during the procedure. The area to be biopsied is “numbed” with Lidocaine, like dentists use.
• A special needle is inserted into the kidney to take a tiny sample of kidney tissue.
• A bandage or dressing is placed tightly over the biopsy site.
• Your child will remain on bed rest after biopsy until 8 a.m. the following day.
• Complications of a kidney biopsy may include:
  • Pain
  • Bloody urine
  • Bleeding (sometimes requiring surgery)
  • Rarely, loss of the kidney

Types of rejection

There are two types of rejection: acute and chronic

• Hyper-acute rejection
  • This may occur within the first day of transplantation
  • It often results in the loss of the transplanted kidney within the first few days after transplant
• Accelerated acute rejection
  • This occurs within the first week after transplantation.
  • It can be treated with medication.
  • Sometimes a procedure called plasmaphoresis is used to treat this.
• Acute rejection
  • This may occur any time after transplant, but it most commonly occurs during the first three months.
  • This is usually a sudden event diagnosed by any or all of the signs and symptoms described earlier.
  • If caught early, it is usually reversible, with little or no damage to the new kidney.
  • This also may occur if medications are missed or not taken appropriately.
• Chronic rejection
  • This is a slow, gradual loss of kidney function which may eventually lead to dialysis or another transplant.
  • There usually are no symptoms except for rising creatinine levels, worsening lab results and high blood pressure.
  • This process cannot be completely prevented or reversed.

Treatment for rejection

After acute rejection is diagnosed, the treatment used depends upon the severity and kind of rejection. In general, treatment consists of increased or more anti-rejection (immunosuppressant) drugs, such as Solu Medrol (steroids).