Rejection is always the main concern of patients and doctors after kidney transplantation. Today, Dr. Zhu and you talk about kidney transplant rejection, I hope to help you.
1. Why does rejection occur after kidney transplantation?
A: when anything“Foreign”, such as bacteria and viruses, enters our bodies, the body’s immune system quickly recognizes and kills it. This is known as immunity. However, the newly transplanted kidneys are also judged to be ‘foreign’ by the immune system and are attacked, a condition known as rejection. In the absence of effective treatment, such attacks can be fatal to a kidney transplant.
2. How Do I know if I’m rejecting something?
A: the symptoms of rejection are becoming less and less typical due to the use of powerful immunosuppressants, but be aware that rejection may occur if the following symptoms occur after a kidney transplant: Call your kidney transplant doctor right away: Pain in the transplant area, stiffening and enlargement of the kidney; fever, temperature over 38 degrees Celsius with no obvious signs of infection; sudden loss of urine output; sudden weight gain; swelling of the hands and feet; swelling of the kidneys Elevated blood pressure.
3. I don’t feel any discomfort, so can I be sure I haven’t had rejection?
A: No. As mentioned in the previous question, rejection is becoming more and more atypical. Most rejections do not have obvious symptoms at the beginning, and routine tests can only show an increase in serum creatinine, even in a subset of patients with normal creatinine levels, renal biopsy results indicate rejection, and medications may need to be adjusted based on pathologic findings. For your safety, regular follow-up after kidney transplantation is essential.
4. Many patients say that kidney transplant biopsy risk is very big, I also think very difficult to do a kidney transplant surgery, do a biopsy will take out a part of the precious glomeruli, this test is necessary?
A: we can assure you that a needle biopsy of a kidney transplant is necessary. Each kidney has about 1 million glomeruli, and we only get about 10 to 20 glomeruli per biopsy, so there’s no need to worry about glomeruli.
Renal biopsy does have certain risks, such as bleeding, but the rate is very low, and there have never been significant complications from renal biopsy in our transplant center. Most importantly, biopsy pathology can differentiate the diagnosis of rejection and drug toxicity, and can clarify the type of rejection. The results are directly related to the follow-up treatment plan, but also related to the recovery of the transplanted kidney.
Therefore, it is not necessary to reject a renal allograft biopsy for fear of complications.
5. What are the types of rejection?
There are many types of rejection according to different principles, and its mechanism mainly includes two aspects: cellular immunity and humoral immunity. The most common acute rejection is mainly mediated by cellular immunity, while hyperacute rejection and chronic rejection are mainly mediated by humoral immunity. However, rejection is often cellular rejection and humoral rejection of the joint participation, it is difficult to completely distinguish between the two, clinical diagnosis is generally based on the main conclusion of the participation.
6. When does rejection occur after kidney transplantation?
A: rejection can occur at any time after kidney transplantation. We usually speak of acute rejection in six months after kidney transplantation, especially within three months of the greatest chance, and then will reduce, but even long after the transplant may still occur acute rejection. Chronic rejection generally occurs six months to a year after kidney transplantation.
7. I have done a good kidney transplant for 10 years, has been quite normal, there will be rejection it? I don’t think I need to go to the hospital regularly re-check, let my family help me to dispensing on it, right?
A: we have touched on this issue before, but it is necessary to emphasize it here separately. Rejection can occur at any time after kidney transplantation. The incidence of chronic rejection increases with time after transplantation, and even acute rejection can occur many years after renal transplantation. So even if you’ve been living with a kidney transplant for 10 years, you still need regular follow-up visits and tests at your doctor’s request, not just prescriptions from family members.
8. What should I do if rejection is suspected?
A: rejection is a serious, even fatal, complication of kidney transplantation. Therefore, if rejection is suspected, you should see your kidney transplant follow-up doctor as soon as possible.
9. What is the risk of rejection?
A: the occurrence of rejection can not be controlled, but it is more likely to occur in the following circumstances: immunosuppressive drugs did not reach the effective concentration; Due to prolonged diarrhea, the immunosuppressant is not fully absorbed.
10. What tests do I need to know if I have rejection?
A: you should have regular hematuria, kidney function and, if necessary, a biopsy of the transplanted kidney. You should also be tested for HLA antibodies.
Text, editor | Zhu Dong, illustration | 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肾移植术后排斥反应知多少
