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After the Transplant | Kidney
The steady improvement in success rates of kidney transplantation means that there are a large number of patients with long-functioning kidney grafts. The overall 1-year survival rate of kidney transplant recipients who receive an organ from deceased donor exceeds 94%, with 5-year survival rates almost 82%
Figure. Survival of living and deceased donor kidney transplant recipients (1997-2004). Based on UNOS/OPTN data as of October 2, 2009.
For recipients of living-donor kidneys, the survival rates are 98% and 90%, respectively.
Advances in medicine, including improvements in surgery and greater understanding in how to use anti-rejection drugs safely and effectively, have contributed to the success of liver transplantation.
There are many types of medications that are used to prevent rejection and there are different formulations of same anti-rejection drug.
The Table lists important information about anti-rejection medications such as dosages and formulations.
Figure. Anti-rejection medications
Your transplant team will adjust the dose depending upon your risk of rejection, your weight, and other medications that you might be taking.
TYPES OF REJECTION
A rejection episode can occur even with anti-rejection drugs especially during the first few months after surgery. The word "rejection" can be frightening. However, rejection does not mean that you will lose your new organ. Knowing what rejection is and how it can be prevented or reversed will help reduce your fears.
Three types of rejection can occur after receiving an organ transplant:
- Hyperacute rejection occurs as soon as the donated organ is transplanted. This rarely occurs because transplant doctors make sure to match blood types and check if you have antibodies against the donated organ
- Acute rejection occurs at least a few days after the transplant surgery when the body has had time to identify a foreign invader.
- Chronic rejection is a very gradual type of graft injury that can occur over months or even years.
DETECTING REJECTION
A rejection episode can usually be reversed if it is caught early. The transplant team can often detect the first signs of rejection, which can occur without any symptomsThat is why it is important to keep all appointments with your transplant team.
You should also recognize the signs and symptoms of rejection. Contact your transplant team immediately if you think you might be having a rejection episode.
Symptoms of rejection of a transplanted kidney or kidney/pancreas graft are listed below:
| Kidney, kidney/pancreas |
- Pain or tenderness over the transplant site
- Fever
- Flu-like symptoms such as chills, nausea, vomiting, tiredness, headache, dizziness, body aches and pains
- Little or no urine output
- Sudden weight gain or swollen feet or ankles
|
The following medical tests can be used to detect rejection of a transplanted kidney.
| Kidney |
Blood urea nitrogen (BUN) and creatinine are measures of the kidney's ability to clear normal waste products |
Elevated BUN or creatinine could mean that the kidney is not functioning properly |
| Protein in urine (proteinuria) - too much protein in urine is not normal |
Protein in the urine is a sign of a kidney disorder |
| Urinalysis measures the amount of white blood cells, red blood cells, bacteria, and protein in the urine |
An abnormal urinalysis could indicate kidney disease |
IMPAIRED FUNCTION AND LOSS OF THE TRANSPLANT
In addition to rejection, there are other reasons why a transplanted organ may not function as well as it should. If your kidney is not working well but you are not experiencing rejection, your doctor will be able to explain what is happening and provide the appropriate treatment.
Impaired function of the implanted kidney over time is the primary reason a transplanted kidney is lost. This process is called chronic allograft nephropathy (CAN) or interstitial fibrosis and tubular atrophy (IF/TA). There can be several factors that cause chronic allograft nephropathy or interstitial fibrosis and tubular atrophy.
Immune factors include acute and chronic rejection; genetic mismatch between donor and recipient; and circulating antibodies against the donor’s genetic types. Other factors not related to the immune system include high blood pressure; chronic toxicity of some anti-rejection drugs; and diabetes. These factors may cause a cycle of injury and scarring of the transplanted kidney, and loss of kidney cells responsible for filtering blood.
References
Banasik. Ann Transplant 2006;11:7–10.
Nankivell Transplantation 2006; 81: 643–654.
Nankivell N Engl J Med 2003;349: 2326–2333.
Pascual. N Engl J Med 2002;346: 580–590.
United Network for Organ Sharing. http://optn.transplant.hrsa.gov/latestData/rptStrat.asp
Yates Transpl Immunol 2006;16: 148–157.