Rejection-

What is Rejection?
Your body's immune system is designed to seek and destry any foreign object that it finds in your body, such as a cold virus, a flu virus, or a transplanted organ.  The process of destroying the foreign object, the transplanted organ, is called rejection.  Rejection occurs as your body's immune system responds to the presence of the transplanted kidney.  Rejection actually shows that your immune system is working. However, in transplant recipients, this immune response needs to be suppressed to protect the transplanted kidney.

There are several types of kidney rejection. These types are described by the kind of cells causing the rejection, when the rejection occurs, and by the severity of the rejection.

Hyperacute Rejection- occurs within minutes of the kidney transplant.  It occurs when the recipient's antibodies immediatly recognize the kidney as forgein and attack it.  An antibody is a protein produced by the immune system.   Antibodies help the body fight organisims that are recognized as forgein, or not belonging to that body.  Hyperacute rejection can not usually be treated and results in the loss of the kidney.  A special test called a crossmatch is completed before the kidney transplant to indentify antibodies that could cause hyperacute rejection.
 
Accelerated Acute Rejection occurs within the first three to seven days after kidney tranplant. It is cause by antibodies that may have been inactive at the time of transplant but get reactivated soon afterwards.  This form of rejection is difficult to treat, but there have been recent improvements i treatments for this type of rejection. Patients with High antibody levels are at high rist for developing this rejection.  Some transplant centers have special treatment protocols for patients with high antibody levels that are used before they receive a transplant.

The most common form of rejection is acute cellular rejection  In this type of rejection, the bodys blood cells identify the kidney as foreign and begin mounting an army of cells to attack the kidney.  Although acute rejection can happen at any time, about 15 to 25% of kidney transplant recipients have at least one mild to moderate episode of acute rejection within the first three months after transplant.  Acute rejection does not mean that you will lose your transplated kidney, but it is very important that rejection is diagnosed and treated as soon as possible.  To help detect rejection, you should have your blood tests completed routinely as requested by your transplant center, and report any symptoms you are having to your transplant center.

If the rejection process does not completely resolve, or if it continues slowly over time this is called chronic rejection. Chronic rejection is more difficult to treat because of more permanent changes in the kidney tissue. 

Signs and symptoms of rejection:
Fever greater than 100
Increased kidney function tests (bun and creatinine)
decreased urine output
tenderness over the graft
swelling in hands, eyelids, or lower extremities
weight gain of 2-4lbs in 24 hours
additionally, you doctor may want you to have a kidney biopsy to confirm that your symptoms are caused by rejection.