Types Of Organ Rejection
The type of organ rejection you experience depends on its timing after transplant:
- Acute rejection: occurs within the first few months
- Chronic rejection: happens after a year or at any time beyond
Acute rejection happens when your bodys immune system treats the new organ like a foreign object and attacks it. We treat this by reducing your immune system’s response with medication.
Chronic rejection can become a long-term problem. Complex conditions can make rejection difficult to treat. Your body, for instance, may develop antibodies to the transplanted organ a disease can also weaken your immune system and trigger an episode.
What Is Kidney Rejection
Rejection is your body’s response to the transplanted kidney’s foreign proteins. Rejection happens when your immune system, which protects your body from germs and foreign proteins, tries to fight your new kidney. Immunosuppressant medicines help keep your body from fighting your new kidney and rejecting it. This is why you take immunosuppressant medicines every day exactly the way your doctor has prescribed.
There are two types of kidney rejection that can happen after transplant:
- Acute rejection usually happens soon in the months after a transplant. Out of 100 people who get a transplant, 5-20 people will have an acute rejection episode and less than five people will have an acute rejection episode that leads to complete failure of their new kidney.
- Chronic rejection happens slowly over the years after a transplant. It means your new kidney may stop working over time because your body’s immune system is constantly fighting it. Chronic rejection happens to kidney recipients more often than acute rejection.
How Do I Know I Am Rejecting My Kidney
When you receive regular kidney-function tests, the patterns of the results will help your doctor observe what is happening to your transplanted kidney. If your blood test results are out of the normal range, your transplant physician or transplant coordinator will discuss the results with you. Some abnormal lab values may be acceptable as you recover from transplant or a related complication and should improve over time. After you leave the hospital, your blood tests will be monitored less frequently. If rejection occurs, you may experience some mild symptoms, although some patients may continue to feel fine for a while. The most common early symptoms include:
- Fever greater than 100°
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Get On The Waiting List
If your tests show you can have a transplant, your transplant center will add your name to the waiting list. Wait times can range from a few months to years. Most transplant centers give preference to people whove been on the waiting list the longest. Other factors, such as your age, where you live, and your blood type, may make your wait longer or shorter.
A transplant center can place you on the waiting list for a donor kidney if your kidney function is 20 or lesseven if you arent on dialysis. While you wait for a kidney transplant, you may need to start dialysis.
What Is The Process For Getting A Kidney Transplant
If you want a kidney transplant, the process includes these steps:
- Tell your doctor or nurse you want to have a kidney transplant.
- Your doctor will refer you to a transplant center for tests to see if youre healthy enough to receive a transplant. Living donors need to be tested to make sure theyre healthy enough to donate a kidney.
- If you dont have a living donor, youll be placed on a waiting list to receive a kidney. Youll have monthly blood tests while you wait for a kidney.
- You must go to the hospital to have your transplant as soon as you learn a kidney is available. If you have a living donor, you can schedule the transplant in advance.
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What Is A Kidney Biopsy
A kidney biopsy is a procedure that involves taking a small sample of kidney tissue from the transplanted kidney so that it can be tested to see if rejection is present. A kidney biopsy can be performed by an interventional radiologist or by a transplant team physician in an outpatient setting or in the hospital.
In order to take a biopsy, the skin above your kidney is numbed with medication and a small nick is made in the skin to allow a small needle to pass through to your kidney. Several kidney tissue samples will be collected. The tissue samples are examined under a microscope to establish a diagnosis. The biopsy procedure generally takes between 20 and 30 minutes. You are required to lie flat for two hours following the procedure to prevent bleeding.
Common Signs & Symptoms That Your Body Is Rejecting Your Transplanted Kidney Or Heart
A person living with a transplanted organ can live a healthy and normal life.
However, to increase your chances of long-term success, experts say that immunosuppressants must be taken every day as directed.1
A transplanted organ is seen as a foreign objector an unwelcome visitorby your body, says Nikhil Agrawal, MD, a nephrologist with Beth Israel Deaconess in Boston. That is why your bodys immune system works hard to react againstor rejectthe transplanted organ. Immunosuppressants suppress your bodys immune system and prevent rejection.
The signs and symptoms of rejection could differ based on your transplanted organ. Below are a few things to look out for if you are a kidney- or heart-transplant recipient.
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Signs And Symptoms Of Rejection
Listed below are some of the signs and symptoms of rejection that you may notice. If you experience any of these symptoms, call the renal transplant coordinator immediately.
- Temperature above 100 degrees F
- High blood pressure
- Pain, swelling or tenderness over the new kidney
- General feeling of fatigue, muscle aches, loss of appetite
- Large weight gain or puffiness
- Increase in blood creatinine level
It is important to note that many rejection episodes result in minimal or no symptoms at all. In these instances, only an increase in the blood creatinine level can suggest to your doctor that there is a problem.
When A Transplant Fails
Everyone talks about the success rates of kidney transplants. Rarely do we talk about what happens when transplants fail.
In the transplant evaluation process, transplant programs talk about the success rates and risks, including that the kidney may never work or won’t work for long, but everyone thinks they will be one of the successes. However, there are a number of reasons why a kidney transplant can fail:
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How Do I Prepare For A Kidney Transplant
To get a kidney from an organ donor who has died , you must beplaced on a waiting list of the United Network for Organ Sharing .Extensive testing must be done before you can be placed on the transplantlist.
A transplant team carries out the evaluation process for a kidney. The teamincludes a transplant surgeon, a transplant nephrologist , one or moretransplant nurses, a social worker, and a psychiatrist or psychologist.Other team members may include a dietitian, a chaplain, and/or ananesthesiologist.
The evaluation includes:
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Mental health evaluation. Psychological and social issues involved in organ transplantation, such as stress, financial issues, and support by family and/or significant others are assessed. These issues can greatly affect the outcome of a transplant. The same kind of evaluation is done for a living donor.
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Blood tests. Blood tests are done to help find a good donor match, to check your priority on the donor list, and to help the chances that the donor organ will not be rejected.
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Diagnostic tests. Diagnostic tests may be done to check your kidneys as well as your overall health status. These tests may include X-rays, ultrasound, kidney biopsy, and dental exams. Women may get a Pap test, gynecology evaluation, and a mammogram.
The transplant team will weigh all the facts from interviews, your medicalhistory, physical exam, and tests to determine your eligibility for kidneytransplantation.
These steps will happen before the transplant:
How Do I Know My New Kidney Is Working
Blood tests help you know your donor kidney is working. Before you leave the hospital, youll schedule an appointment at the transplant center to test your blood. The tests show how well your kidneys are removing wastes from your blood.
At first, youll need regular checkups and blood tests at the transplant center or from your doctor. As time goes on, youll have fewer checkups.
Your blood tests may show that your kidney is not removing wastes from your blood as well as it should. You also may have other symptoms that your body is rejecting your donor kidney. If you have these problems, your transplant surgeon or nephrologist may order a kidney biopsy.
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Blood Tests That Monitor Your Transplanted
Your doctor will order regular labs to help monitor the health of your new organ. These labs may include surveillance options like AlloSure or AlloMap .
RemoTraC® is a service that brings a phlebotomist to your home to draw your blood for a panel of standard transplant labs, whichin addition to AlloSure or AlloMap surveillance testsinclude:
What Is Transplant Rejection
Rejection is your body’s way of not accepting the kidney transplant. Although rejection is most common in the first six months after surgery, it can occur at any time. Fortunately, the transplant team can usually recognize and treat a rejection episode before it causes any major or irreversible damage. It is very important for you to continuously take your medications as prescribed and have your blood work drawn as scheduled.
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Kidney Transplant Rejection: What You Need To Know
Since the first kidney transplant more than 60 years ago,1 doctors have developed a deeper understanding of how to protect donated organs. With newer medications and improved management, its less likely transplanted kidneys will undergo rejection by the immune system.
Thats not to say doctors have completely eliminated the risk of kidney transplant rejection, though. Unfortunately, while many kidneys will last much longer, the median life of a kidney transplant is still only ten years. Understanding the risks and early warning signs of rejection gives you the best chance of a successful kidney transplant.
Your Role In Transplant Success
You are the most important member of your transplant team.
To maintain your health, as an organ transplant recipient, you will have the best outcomes if you:
- Take your medication consistently and don’t miss a dose
- Go to all your appointments
- Complete all required lab tests
- Communicate with us
If you get sick, or another doctor prescribes you a medication, you will need to let us know. We will have to determine:
- The nature of your illness, and whether it relates to your transplant
- If it is the best prescription or medicine for you
- If the medication will interact with your immunosuppressant
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Enhancing Healthcare Team Outcomes
Patients with renal transplants require a comprehensive interprofessional team approach in post-transplant care, including clinicians from different disciplines, nurses, social workers, and other health professionals. Together as a team, they play a significant role in better outcomes of renal allograft survival.
While the transplant surgeon is the chief clinician involved, the specialty-trained transplant nurse will provide invaluable support. This includes patient preparation, assisting during the surgery, and providing post-operative care. As the patient starts on post-procedure pharmacotherapy, a board-certified pharmacotherapy pharmacist should consult on the case to optimize agent selection, dosing, and provide patient counsel. The transplant nurse will also monitor the patient and inform the treating clinician of any concerns or significant status changes. Given the lifelong follow-up necessary after a transplant, these players functioning as an interprofessional team on behalf of the patient will optimize the outcomes with the new organ, and minimize the chances for organ rejection.
How Will I Feel After My Transplant
Many people report feeling much better right after having transplant surgery. For some people, it takes a few days for the new kidney to start working. You probably will need to stay in the hospital several days to recover from surgerylonger if you have any problems after the transplant. Youll have regular follow-up visits with your nephrologist after leaving the hospital.
If you have a living donor, the donor will probably also stay in the hospital for several days. However, a new technique for removing a kidney for donation that uses a smaller cut may make it possible for the donor to leave the hospital in 2 to 3 days.
Before you leave the hospital, you need to learn how to stay healthy and take care of your donor kidney. You will have to take one or more anti-rejection medicinesalso called immunosuppressants. Without medicine, your immune system may treat your donor kidney as foreign, or not your own, and attack your new kidney. Anti-rejection medicines may have side effects.
You may also need to take other medicinesfor example, antibiotics to protect against infections. Your transplant team will teach you what each medicine is for and when to take each one. Be sure you understand the instructions for taking your medicines before you leave the hospital.
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Who Is On My Transplant Team
A successful transplant involves working closely with your transplant team. Members of the team include:
- Youyou are an important part of your transplant team.
- Your family membersthis may include your spouse, parents, children or any other family member you would like to involve.
- Transplant surgeonthe doctor who places the kidney in your body.
- Nephrologista doctor who specializes in kidney health and may work closely with a nurse practitioner or a physicians assistant.
- Transplant coordinatora specially trained nurse who will be your point of contact, arrange your appointments, and teach you what to do before and after the transplant.
- Pharmacista person who tells you about all your medicines, fills your prescriptions, and helps you avoid unsafe medicine combinations and side effects.
- Social workera person trained to help you solve problems in your daily life and coordinate care needs after your transplant.
- Dietitianan expert in food and nutrition who teaches you about the foods you should eat and avoid, and how to plan healthy meals.
Your transplant team will be able to provide the support and encouragement you need throughout the transplant process.
Have Your Kidney Transplant
During kidney transplant surgery, a surgeon places a healthy kidney into your body. Youll receive general anesthesia before the surgery. The surgery usually takes 3 or 4 hours. Unless your damaged kidneys cause infections or high blood pressure or are cancerous, they can stay in your body. Surgeons usually transplant a kidney into the lower abdomen near the groin.
If youre on a waiting list for a donor kidney, you must go to the hospital to have your transplant surgery as soon as you learn that a kidney is available.
If a family member or friend is donating the kidney, youll schedule the surgery in advance. Your surgical team will operate on you and your donor at the same time, usually in side-by-side rooms. One surgeon will remove the kidney from the donor, while another prepares you to receive the donated kidney.
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High Cholesterol And Blood Lipids
What are my chances of having high cholesterol and blood lipids after kidney transplant?
Many people may have higher cholesterol and lipid levels in the blood after transplant due to medication side-effects , weight gain, poor diet, family history, or lack of exercise. Kidney-related issues that cause protein in the urine can also increase blood lipids.
Why should I worry about high cholesterol and blood lipids?
High blood lipids can lead to clogged blood vessels. When this occurs it increases risk of heart disease and stroke.
How can I control my cholesterol and blood lipids?
Your doctor will help you manage your cholesterol and blood lipids. Controlling high cholesterol and blood lipids is usually done with:
- A heart healthy diet
How To Deal With Kidney Transplant Rejection
The treatment for hyperacute rejection, which is often severe and occurs within minutes, is immediate. It involves total removal of the foreign tissue. However, for chronic rejection, which responds poorly to treatment and is considered irreversible, only re-transplant can be helpful. Investigation on the use of inhaled cyclosporine is also being done to prevent or delay chronic rejection in lung transplants.
For acute kidney transplant rejection, a few treatment strategies may be done:
1. Medication
Some immune-suppressing drugs can be helpful, such as
- Cyclosporine, which interferes with T cell communication in the immune system. Treatment starts immediately after the kidney transplant to overpower the immune system and it is indefinitely continued.
- Corticosteroids, which also block T cell communication. They are often given at high doses immediately after the kidney transplant, and then the dose will be, reduced. Doses are increased if rejection later occurs.
- Azathioprine, which slows the production of T cells. It is typically used for maintenance of long-term immunosuppression.
- Other newer drugs include sirolimus, tacrolimus and mizoribine , which all decrease the response of the immune system to the new kidney.
2. Blood Transfusions
These are sometimes given to patients who do not respond to antibody or immunosuppressive therapy by removing antibody molecules that are specific to the transplanted kidney.
3. Bone Marrow Transplant
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Special Programs For Living Donor Transplantation
Many patients have relatives or non-relatives who wish to donate a kidney but are not able to because their blood type or tissue type does not match. In such cases, the donor and recipient are said to be “incompatible.”
See also: National Kidney Registry
Live Donor to Deceased Donor Waiting List Exchange
This program is a way for a living donor to benefit a loved one, even if their blood or tissue types do not match. The donor gives a kidney to another patient who has a compatible blood type and is at the top of the kidney waiting list for a “deceased donor” kidney. In exchange, that donor’s relative or friend would move to a higher position on the deceased donor waiting list, a position equal to that of the patient who received the donor’s kidney.
For example, if the donor’s kidney went to the fourth patient on the deceased donor waiting list, the recipient would move to the fourth spot on the list for his or her blood group and would receive kidney offers once at the top of the list.
Paired Exchange Kidney Transplant
This program is another way for a living donor to benefit a loved one even if their blood or tissue types do not match. A “paired exchange” allows patients who have willing but incompatible donors to “exchange” kidneys with one another-the kidneys just go to different recipients than usually expected.
That means that two kidney transplants and two donor surgeries will take place on the same day at the same time.
Blood Type Incompatible Kidney Transplant