Kidney Transplant

What You Need to Know About Kidney Transplant Rejection

When someone receives a kidney transplant, their immune system recognizes the new organ as foreign and attacks it. This is known as kidney transplant rejection, and it is a common concern for those who undergo this life-saving procedure. In this document, we will discuss six important things you need to know about kidney transplant rejection.

Types of Rejection

There are three main types of kidney transplant rejection: hyper-acute, acute, and chronic. Hyper-acute rejection occurs within minutes to hours after the transplant surgery and is typically caused by pre-existing antibodies in the recipient’s blood. Acute rejection happens within the first few months after transplantation and can be treated with medication. Chronic rejection occurs over a longer period of time and is often irreversible. This is a slow and progressive type of rejection that can occur months or years after transplantation. Chronic rejection is characterized by the gradual loss of kidney function over time. It is believed to be caused by a combination of immune responses and other factors, such as inflammation and scarring. Unfortunately, chronic rejection is difficult to treat, and it often leads to the eventual failure of the transplanted kidney.


Symptoms of kidney transplant rejection may include fever, pain or tenderness over the transplant site, decreased urine output, and swelling in the lower extremities. Rejection can cause flu-like symptoms such as fever, chills, body aches, and fatigue. These symptoms may indicate an immune response against the transplanted kidney. A sudden decrease in urine output or changes in urine color, such as darkening or blood in the urine, may be a sign of kidney rejection. This occurs because the immune system’s attack on the transplanted kidney can lead to impaired kidney function. Regular monitoring of blood tests is crucial after a kidney transplant. An increase in creatinine levels in the blood may indicate kidney rejection or dysfunction. These symptoms can also be caused by other factors, so it is important to communicate any changes or concerns with your transplant team.

Risk Factors

Several factors can increase the risk of kidney transplant rejection, including not taking immunosuppressant medication as prescribed, having a mismatched or poorly matched donor, and having previous episodes of acute rejection. Individuals who have previously experienced rejection of a transplanted organ, such as a kidney, are at a higher risk of rejection in future transplant procedures. This is because their immune system may be more sensitized to the foreign tissue.

Following the prescribed medication regimen is vital after a kidney transplant. Failure to take immunosuppressive medications as directed can increase the risk of rejection. It’s crucial to take medications regularly and on time to suppress the immune system and prevent rejection


If your transplant team suspects rejection, they will perform tests to confirm it. These may include blood tests, urine tests, and a biopsy of the transplanted kidney. It is crucial to monitor for rejection so that it can be addressed promptly. Blood tests are crucial for assessing kidney function and detecting signs of rejection. Elevated levels of creatinine, a waste product that the kidneys usually filter out, can indicate kidney dysfunction. Additionally, tests may be conducted to measure the level of donor-specific antibodies (DSA) or other markers associated with rejection.

It’s important to note that the specific diagnostic approach may vary depending on the individual case and the healthcare facility. Prompt diagnosis of rejection is crucial to initiate appropriate treatment and prevent further damage to the transplanted kidney.


Treatment for kidney transplant rejection typically involves increasing or changing immunosuppressant medication, which helps to suppress the immune system’s response to the new organ. In some cases, additional therapies, such as plasmapheresis or intravenous immunoglobulin, may be used to remove harmful antibodies from the blood or block their effects. Severe rejection episodes may require hospitalization and more aggressive treatments, such as high-dose steroids or antibody therapy.

It’s essential to work closely with your transplant team if you experience any symptoms of rejection. They will monitor your progress closely and prescribe the most appropriate treatment plan for your specific case.