All along, rejection is a common concern after transplantation. Compared with acute rejection, chronic rejection is more difficult to diagnose and treat, and is closely related to the long-term survival of renal allograft. Once chronic rejection is not diagnosed and treated in time, it often leads to a series of complications such as hypertension and proteinuria, resulting in further irreversible damage and loss of graft function.
What is chronic rejection?
Chronic renal allograft rejection is defined as rejection that occurs more than 3 to 6 months after transplantation and is characterized by progressive decline in renal function, hypertension, and proteinuria, leading to kidney failure, return to dialysis or retransplantation. The onset of chronic rejection is more insidious and not as aggressive as acute rejection, so it is not easily noticed by patients, some patients who don’t have regular follow-up often miss the best time of treatment because they can’t find the disease early.
What factors can induce chronic rejection?
The specific pathogenesis of chronic rejection is not fully understood in medicine. It is known that many immunological and non-immunological factors are closely related to the induction of chronic rejection. Immunological factors include Human leukocyte antigen mismatch, acute rejection, subclinical rejection, and chronic underdosing of immunosuppressants, non-immune factors include delayed graft function, immunosuppressive nephrotoxicity, Cytomegalovirus and polyomavirus (e.g. , BKV) infections, hyperlipidemia, hypertension, and proteinuria.
In addition, in addition to the above factors, chronic rejection is also closely related to drug compliance. Patients who do not comply with medical orders and do not follow up on time often suffer irreversible kidney damage due to long-term insufficient doses of immunosuppressants or acute rejection and chronic rejection induced by viral infection.
How to deal with chronic rejection?
Chronic rejection is difficult to diagnose and treat. Before making a diagnosis, the doctor must rule out other causes of kidney damage, such as obstruction, reflux, renal stenosis, infection, and acute rejection, it should be differentiated from drug nephrotoxicity and recurrence of primary nephrosis. Programmed renal biopsy can detect the underlying lesions at an early stage, which plays an important role in the early diagnosis and timely intervention of chronic rejection.
Patients with chronic rejection need comprehensive treatment, including adjustment of immunosuppressants, effective control of blood pressure, correction of dyslipidemia and improvement of renal blood flow and proteinuria. In principle, if some“Early” patients with chronic rejection can be treated in a timely manner, under the ideal immunosuppressive program and comprehensive treatment, renal allograft function may remain stable for an extended period of time or the progression of the disease may be slowed. Once the clinical symptoms of proteinuria, hypertension, etc. are significant, it will become very difficult to deal with.
Therefore, for kidney transplant patients, regular follow-up and procedural renal allograft biopsy are very important, so that doctors can find problems in time and review the immunosuppressive regimen according to the change of disease, in order to deal with chronic rejection in time.
Text, editing | Sun Jiajia, photography | G.T.
This article is an original article of”Kidney Transplantation, sun yat-sen hospital, Fudan University”. It is reproduced with the author’s permission and marked with the source. Care about the kidney, from the concern”Fudan University affiliated Zhongshan Hospital Kidney Transplant” public wechat start, you can also click [ read the original ] , view肾移植后你该注意（四）：高尿酸
