Uremia is a major disease affecting human health. At present, kidney transplantation is the most effective treatment for uremia. Since the first kidney transplant was performed in 1954 by Dr. Murray in the United States, nearly one million uremic patients worldwide have received a kidney transplant.
In recent years, with the continuous improvement of medical level, the continuous accumulation of clinical experience of transplant physicians, the continuous improvement of surgical skills, the improvement of organ preservation and the application of various new immunosuppressants, the clinical experience of transplant surgeons has been improved, the clinical outcome of renal transplantation has been significantly improved, and the incidence of acute rejection has been significantly reduced.
Nevertheless, rejection remains an independent risk factor for long-term allograft survival. Therefore, we need to attach great importance to the occurrence of rejection after renal transplantation.
What is rejection?
Rejection is when a uremic patient receives a kidney of a different genetic background because of the different antigens of the donor and recipient, without the use of immunosuppressants, the transplanted kidney may be“Attacked” by the body’s lymphocyte immune-competent cells and antibodies.
In short, when a kidney transplant recipient receives a kidney transplant, our immune system recognizes the“Foreign” kidney as an“Alien” component, in response to which it is attacked, destroyed, and eliminated.
How are rejections classified?
Clinically, rejection is usually divided into four types according to the time of occurrence: hyperacute rejection, accelerated rejection, acute rejection and chronic rejection. According to its pathogenesis, rejection can be divided into cell-mediated (cellular) rejection and antibody-mediated (humoral) rejection. Let me just briefly introduce the different types of rejection.
Hyperacute rejection, as the name suggests, occurs earliest, usually within minutes to hours after transplantation, usually within 24 hours, is the most violent and the most serious kind of rejection. Due to the improvement of tissue matching technology and the application of immunosuppressants, such rejection has been very rare. However, there is no effective treatment for hyperacute rejection. Once the diagnosis is confirmed, the kidney should be removed as soon as possible.
Accelerated rejection usually occurs within 1-7 days after transplantation. It is a kind of rejection between hyperacute rejection and acute rejection, renal allograft function is often rapidly lost. Accelerated rejection is generally difficult to treat, the effect is poor, the current clinical commonly used anti-thymocyte globulin (ATG) , anti-lymphocyte globulin (ALG) treatment.
Acute rejection is the most common rejection after kidney transplantation, which can occur at any stage after transplantation, but most occur within 1-3 months after transplantation. The common cause of acute rejection is the insufficient dose of immunosuppressant caused by various reasons, such as sudden reduction or withdrawal of immunosuppressant, frequent vomiting and diarrhea, and significant weight gain in the short term.
If there is no specific cause of decreased urine output, weight gain, elevated blood pressure, blood creatinine and urea nitrogen increased test results, this situation should be highly suspected of the occurrence of acute rejection. At this time should be timely medical treatment, if not timely treatment can lead to serious kidney transplant damage or even loss of function. When acute rejection occurs, steroid pulse therapy or ATG therapy is often used clinically.
Chronic rejection generally occurs 3-6 months after transplantation and is the main factor affecting the long-term survival of renal allografts. The main clinical manifestations were proteinuria, hypertension and progressive renal allograft dysfunction. Chronic rejection is primarily diagnosed by biopsy of the transplanted kidney. At present, there is no particularly effective treatment for chronic rejection. The goal of treatment is to prevent progressive deterioration of renal function as much as possible.
In short, after kidney transplantation, we should take immunosuppressants according to the Doctor’s advice and consult the doctor on time, adjust the drugs under the guidance of the Doctor, do not reduce the drugs or even stop the drugs at will, and seek medical attention in a timely manner once abnormalities are found, cherish this hard-won kidney.
Text, editing | Xu Shihao, illustrations | Nancy
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肾移植受者：自我管理“知多少”
