Acute rejection treatment
Acute rejection now occurs in less than 20% of recipients and the likelihood of renal graft loss secondary to acute rejection within the first year is only about 10% for cadaveric grafts and five percent for living related donor kidneys. The introduction of newer potent medications is responsible for fewer acute rejections, and, when it occurs, for reducing its signs and symptoms. Compared to previous decades, when patients developed fever, tender renal graft, hypertension, and reduced urinary output, the onset of acute rejection is often quite subtle. Presently, the only sign is often only a modest rise in the serum creatinine concentration. Often, a percutaneous needle graft biopsy is required to determine if the serum creatinine elevation is due to acute rejection, or calcineurin nephrotoxicity.
A short course of high dose IV methylprednisolone is usually effective for acute rejection. If unsuccessful, administration of monoclonal antibody (OKT3) directed against CD3 T cells is usually effectual since acute rejection is mediated by activated T lymphocytes. The threat of life-threatening side effects requires premedication and very close observation, at least during the first few daily doses.