October 28, 2024, Immune Tolerance
Rejection remains the primary concern for both patients and doctors following kidney transplantation. Today, Dr. Zhu will discuss kidney transplant rejection with you, hoping to provide assistance.
1. Why Does Rejection Occur After Kidney Transplantation?
Answer: When any “foreign” entity, such as bacteria or viruses, enters our body, the immune system rapidly recognizes and eliminates it. This is known as immunity. However, the newly transplanted kidney is also identified as “foreign” by the immune system and is attacked, a condition known as rejection. Without effective treatment, these attacks can be fatal to the transplanted kidney.
2. How Can I Tell If I’m Experiencing Rejection?
Answer: Due to the use of potent immunosuppressants, the symptoms of rejection are becoming increasingly atypical. However, be alert for potential rejection if the following symptoms appear after a kidney transplant: Contact your kidney transplant doctor immediately.
- Pain in the transplant area, with the kidney becoming stiff and enlarged.
- Fever, with a body temperature exceeding 38°C and no clear signs of infection.
- Sudden reduction in urine output.
- Sudden weight gain.
- Swelling of the hands and feet.
- Elevated blood pressure.
3. If I Don’t Feel Any Discomfort, Can I Be Certain I Haven’t Experienced Rejection?
Answer: No. As noted in the previous question, rejection is becoming increasingly atypical. Most rejections initially lack obvious symptoms, and routine tests may only reveal elevated serum creatinine levels. Even among some patients with normal creatinine levels, renal biopsy results may indicate rejection, necessitating medication adjustments based on pathological findings. For your safety, regular follow-up visits after kidney transplantation, as prescribed, are essential.
4. Many Patients Say That a Kidney Transplant Biopsy Carries Significant Risk, and I Also Find Kidney Transplant Surgery Challenging. Since a Biopsy Removes Some Precious Glomeruli, Is This Test Necessary?
Answer: We can confidently assure you that a needle biopsy of a kidney transplant is necessary. Each kidney contains approximately 1 million glomeruli, and we only extract about 10 to 20 glomeruli per biopsy, so there is no need to worry about their loss. While renal biopsy does carry certain risks, such as bleeding, the incidence is very low, and our transplant center has never experienced significant complications from renal biopsies. Most importantly, biopsy pathology can distinguish between rejection and drug toxicity, and can specify the type of rejection. The results directly influence the subsequent treatment plan and the recovery of the transplanted kidney. Therefore, it is unnecessary to avoid a kidney allograft biopsy out of fear of complications.
5. What Types of Rejection Exist?
Rejection can be classified into various types based on different criteria, with its mechanisms primarily involving cellular immunity and humoral immunity. The most common form, acute rejection, is primarily mediated by cellular immunity, whereas hyperacute rejection and chronic rejection are predominantly mediated by humoral immunity. However, rejection often involves the combined action of cellular and humoral rejection, making it challenging to fully differentiate between the two. Clinical diagnosis typically concludes based on the predominant mechanism involved.
6. When Does Rejection Occur After Kidney Transplantation?
Answer: Rejection can occur at any time following kidney transplantation. We typically describe acute rejection as most likely to occur within the first six months after kidney transplantation, especially within the first three months, when its likelihood is highest, though it decreases thereafter. However, acute rejection can still occur even many years after transplantation. Chronic rejection generally occurs between six months and one year after kidney transplantation.
7. I’ve Had a Successful Kidney Transplant for 10 Years and Everything Has Been Normal. Could Rejection Still Occur? I Don’t Think I Need Regular Hospital Checkups—Can My Family Just Help Me Pick Up My Medications, Right?
Answer: We’ve addressed this issue previously, but it warrants specific emphasis here. Rejection can occur at any time following kidney transplantation. The incidence of chronic rejection rises over time post-transplantation, and even acute rejection can occur many years after kidney transplantation. Therefore, even if you’ve lived with a kidney transplant for 10 years, you still require regular follow-up visits and tests as prescribed by your doctor, rather than relying solely on family members to obtain prescriptions.
8. What Should I Do If I Suspect Rejection?
Answer: Rejection is a serious, potentially fatal complication of kidney transplantation. Therefore, if you suspect rejection, you should consult your kidney transplant follow-up doctor as soon as possible.
9. What Are the Risks of Rejection?
Answer: The occurrence of rejection cannot be fully controlled, but it is more likely to occur under the following circumstances: immunosuppressive drugs do not reach effective concentrations. Due to prolonged diarrhea, immunosuppressants are not fully absorbed.
10. What Tests Are Needed to Determine If I Have Rejection?
Answer: You should undergo regular tests for hematuria and kidney function, and, if necessary, a biopsy of the transplanted kidney. You should also be tested for HLA antibodies.
Written by | Zhu Dong, Edited by | Zhu Dong, Illustrations | Nancy
This article is an original publication of the “Kidney Transplantation, Zhongshan Hospital, Fudan University” WeChat public account. Reproduction requires authorization from this account and the original author, with proper attribution. To care for your kidneys, begin by following the “Kidney Transplantation, Zhongshan Hospital, Fudan University” WeChat public account. You can also click [Read the Original] to explore Understanding Rejection After Kidney Transplantation.
