Rejection of a kidney transplant

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Teen boy resting head against a wall and looking sad

When you get a new kidney, your body doesn’t recognize it. Because it thinks it is a foreign body, your body’s first response is to attack it with special fighting cells from your immune system. This can cause rejection. If this happens, your kidney can be damaged and stop working properly.

The immunosuppressants (anti-rejection medications) you will be taking help prevent rejection. But even if you take them exactly as you should, you can still sometimes get a rejection. However, you should always take your medications as instructed by your transplant team.

Your body is much more likely to reject your new kidney if you decrease your dose (take less than you have been prescribed), miss medications or stop your medications.

Rejection can be:

  • acute
  • chronic

Acute rejection

Acute rejection can start anytime but is most common in the first few months after transplant. Typically, you will not know if you have acute rejection, as you will not have any symptoms or feel any different.

Your transplant team can only test for acute rejection by doing frequent bloodwork or doing a biopsy. As a result, it is very important that you have your bloodwork done exactly as ordered by your doctor. It is the only way that your transplant team can be sure if any problems are occurring.

There are two types of acute rejection – cellular and antibody-mediated.

Cellular rejection can usually be treated with medicine (such as extra prednisone) so that your kidney can work normally again.

Antibody-mediated rejection happens when harmful antibodies from your blood attack the kidney. Treatment is more complicated than for cellular rejection. It can include giving more medications, such as rituximab, giving immunoglobulin by an IV each month and/or performing a procedure called plasmapheresis (say: plaz-ma-fer-EE-siss), which acts a little like dialysis to remove the harmful antibodies. Your transplant team will decide which treatment is best for you.

Chronic rejection

Acute rejection happens quite quickly, but chronic rejection is a longer process that damages the kidney slowly over time. This is often the reason a kidney can fail years after your transplant.

There is no specific treatment for chronic rejection. However, your transplant team may adjust your medications to slow down the process and allow your kidney to work for longer. It is important that you do not change anything related to your medications without talking to your transplant team first.

If your kidney fails because of chronic rejection, you will need to go on dialysis and wait for a second transplant when a suitable kidney becomes available.

Last updated: November 30th 2017