Acute rejection treatment
Acute rejection treatment is required for a kidney transplant patient who has suffered HUS.
Acute rejection now occurs infrequently in kidney transplant patients. The likelihood of renal graft loss secondary to acute rejection within the first year is less than 10% for cadaveric grafts and less than 5% for living related donor kidneys.
The introduction of newer potent medications is responsible for fewer acute rejection episodes, and if they occur, for reducing their intensity. Compared to previous decades, when patients developed fever, tender renal graft, hypertension, and reduced urinary output, the onset of acute rejection is now often quite subtle. Presently, the only sign is usually 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 primarily by activated T lymphocytes. The threat of life-threatening side effects require premedication and very close observation, at least during the first few daily doses.