Kidney transplantation offers a renewed quality of life for individuals with end-stage renal disease. A potential challenge is the body’s immune system identifying the new kidney as foreign. This immune response, known as rejection, is a serious complication. Medical advancements have made rejection a manageable condition, allowing many transplant recipients to live healthy lives.
Recognizing Rejection Signs
A persistent low-grade fever may indicate rejection. Changes in urine output, such as a decrease in amount or alterations in color, may also signal rejection.
Swelling in the legs, ankles, or around the transplanted kidney can occur due to fluid retention. Pain or tenderness over the transplanted kidney site is common. Fatigue, a general feeling of unwellness, or flu-like symptoms like chills and body aches may also occur. An unexplained increase in blood pressure can also indicate rejection. Seek immediate medical attention if these signs appear, as early detection improves treatment success.
Types of Rejection
Rejection is classified by timing and immune mechanisms. Hyperacute rejection is rare due to pre-transplant cross-matching. It occurs almost immediately after transplant when pre-formed antibodies rapidly attack the donor organ, causing irreversible damage.
Acute rejection is the most common type, occurring days, weeks, or even years after transplant, often within the first year. It involves T-cells (cellular) or antibodies (antibody-mediated) attacking the kidney. Acute rejection is often treatable with medication, especially when identified early.
Chronic rejection is a gradual process unfolding over months or years. It leads to progressive scarring and damage within the transplanted kidney, making it challenging to treat effectively. This can ultimately lead to a decline in kidney function and transplant failure.
Medical Diagnosis and Treatment
Diagnosis of kidney transplant rejection involves several methods, beginning with routine laboratory tests. Blood tests, such as those measuring creatinine levels, help assess kidney function, as elevated levels can indicate that the kidney is not filtering waste effectively. Urine tests can also provide insights into kidney health. Imaging techniques, such as an ultrasound of the kidney, may be used to visualize the organ and assess blood flow.
The definitive diagnostic tool for rejection is a kidney biopsy. This procedure involves taking a small tissue sample from the transplanted kidney, typically using a needle, which is then examined under a microscope for signs of immune attack or damage. The biopsy results guide the medical team in determining the specific type and severity of rejection, which is crucial for tailoring treatment.
Treatment for rejection primarily focuses on suppressing the immune system to stop the attack on the kidney. Doctors often increase the dosage of existing anti-rejection medications or introduce new, more potent immunosuppressants. High-dose corticosteroids, such as prednisone, are frequently used to quickly reduce immune activity. For antibody-mediated rejection, specific therapies like monoclonal antibodies or plasmapheresis may be employed to remove harmful antibodies from the blood. If kidney function significantly declines despite treatment, temporary or long-term dialysis might become necessary to support the body’s filtering needs.
Living with Rejection
Individuals who experience kidney transplant rejection require ongoing medical monitoring. Regular follow-up appointments with the transplant team, coupled with consistent blood and urine tests, are important for tracking kidney function and detecting any recurrence of rejection. Open communication with healthcare providers ensures that any new symptoms or concerns are addressed promptly.
Strict adherence to the prescribed medication regimen is crucial, even after a rejection episode has been successfully treated. Missing doses of immunosuppressant medications can increase the risk of further rejection or transplant failure. While medication is a primary focus, maintaining a healthy lifestyle, including a balanced diet, regular exercise, and avoiding infections, supports the transplanted kidney’s health.
Experiencing rejection can be emotionally challenging, bringing stress and anxiety about the transplant’s future. Access to support systems, whether through family, friends, or professional counseling, can be beneficial in navigating these emotional impacts. The outcomes of a rejection episode can vary; some kidneys fully recover function after treatment, while others may experience partial recovery with permanently diminished function. In some instances, the transplanted kidney may ultimately fail, necessitating a return to dialysis or consideration for another transplant.