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Understanding Transplant Rejection

Rejection is a scary word for the transplant patient as well as for their family, friends and the team from the transplant center. Everyone would love the transplant event to be with little or no setbacks and with a smooth transition from hospital to home and back into the swing of things. While this is certainly the case many times, rejection is a reality for the transplant recipient to understand.

When you hear the term rejection it should send off an alarm that something is not going as smoothly as hoped. However, it does not mean doom and gloom. Rejection is just another of the many hurdles that must be overcome to reach the finish line, which is the full functioning of the transplanted kidney.

Our team works hard when faced with a rejection episode. Note the term "rejection episode." This means that an event is occurring which requires intervention by the transplant team. It does not mean the kidney will never work or has stopped working completely. It is an episode in which the kidney for some reason is not working to the expected levels.

The immune system in our bodies is our protection against any "foreign bodies" that get inside. In a normal situation the immune system deals with a virus or bacteria and guards against attack by these foreign bodies. A newly transplanted kidney is seen by the immune system as an enemy which must be attacked and destroyed. Think of this system as your own little army of soldiers and the concept will become more clear.

In any army there is a front line of soldiers. In the immune system these are called Lymphocytes (a type of white blood cell). Your body determines that there is a foreign body present (kidney) this is an antigen. The soldiers (lymphocytes) are called out and sent to destroy the enemy (kidney).

When the lymphocytes have detected the presence of the enemy, in this case , the new kidney, they start to attack right away. Some of the soldiers called antibodies are the advanced scouts and search for the foreign object. Once discovered the antibodies send back a message to get more and more lymphocytes involved in the war.

What happens now is a war between your immune system and the foreign object that has been detected. The immune system is on a seek and destroy mission under the concept that your body needs protecting. This is all well and good if you have a virus or a bacterial infection. It is not good if you have a kidney transplant.

It is our job as the transplant team to try and minimize the rejection episodes. This is done with a strict medical protocol to establish the type of rejection, the cause of the rejection episode and the proper treatment to turn around this event.

There are three types of rejection most commonly noted in the kidney transplant patient. Hyperacute rejection, Acute Rejection and Chronic Rejection are the three categories of rejection episodes.

Hyperacute Rejection occurs very quickly post transplant and is rare. This episode of rejection usually happens during surgery or just after completion during the first several hours of recovery. Hyperacute Rejection causes immediate and complete failure of the newly transplanted kidney. Prevention for this type of rejection is careful analysis of the match between the donor and the recipient based on the data provided by the Regional Organ Procurement Organization or UNOS.

Acute Rejection is the most common type of rejection in the newly transplanted kidney patient. Developing in a short time span it most often occurs during the first two or three months after surgery. Acute rejection however, can occur up to one year post transplant. It is important for the newly transplanted patient to be aware of any changes in their health and to bring it to the attention of our team immediately. Acute rejection can be treated with careful modulation of medications and continued monitoring.

Chronic rejection is the type of rejection that happens over an extended period of time. This type of rejection could result in the loss of the kidney if it can not be corrected. Usually occurring after the first year, The causes of chronic rejections is often unknown and could even be a result of the reoccurrance of the original disease. The best prevention for chronic rejection is a strict adherence to the anti-rejection medications and a general effort to stay as healthy as possible.

 

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