One of the most common causes of allograft dysfunction is a rejected kidney graft, despite It’s became less prevalent
CLINICAL MANIFESTATIONS AND DIAGNOSIS OF ACUTE RENAL ALLOGRAFT REJECTION
One of
the most common causes of allograft dysfunction is a rejected kidney graft, despite
It’s became less prevalent since the admission of more robust immunosuppressive
strategies, especially the calcineurin inhibitors (CNI).
Certain rejected grafts, however, cannot resume its function again despite the
administration of maximum antirejection agents. The recurrence of acute
rejection attacks may negatively affect the long-term allograft outcome. The
two major types of acute rejection episodes are the cellular type and antibody
mediated one.
Another subclinical form can be present if there’re histologic criteria in
allograft biopsy with no associated allograft dysfunction.
Acute
episodes of rejection can be observed through the first 6 months post-transplant.
Rejection episode after 6 months, is primarily related to patient’s non-compliance
or due to rapid immunosuppressives reduction/withdrawal. Historically,
the classic clinical manifestations may include pyrexia, malaise, oliguria (low
urine output), locally tender/painful allograft, allograft swelling and
hypertension (HT), however, with the
advent of the new immunosuppressive protocols, this presentation is not common and
many kidney transplant recipients (KTRs)
mostly present only with a rise in serum creatinine levels (SCR) that suggest the possibility of a
rejection episode.