Book Chapter

Clinical Allograft Rejection Syndromes in Kidney Transplantation

Nankivell, Brian J.

2014

Overview

Transplantation from a non‐identical donor initiates a recipient immune response directed toward donor antigens, manifest as rejection, and expressed as differing pathophysiological syndromes. Primary non‐function due to hyperacute rejection from preformed antibodies is rare, compared with more common ischemia–reperfusion injury. Early acute T‐cell mediated interstitial rejection usually resolves with pulse corticosteroids, whereas vascular, antibody‐mediated, severe interstitial or recurrent rejections result in allograft damage, functional impairment, and require additional therapies. Progressive allograft dysfunction is detected by serial monitoring of serum creatinine, investigated by assessment of therapeutic drug levels, urinalysis, imaging, and timely diagnostic biopsy. Chronic rejection or late acute rejection from non‐adherence can cause irreversibly damage leading to graft failure. Non‐immune causes of dysfunction include ischemia–reperfusion injury, ureteric obstruction, vascular impairment, calcineurin inhibitor nephrotoxicity, recurrent glomerular disease, and BK viral nephropathy. A specific etiologic diagnosis is needed for rational and specific treatment directed towards the dominant pathophysiological cause of dysfunction.

• Publisher: John Wiley & Sons, Ltd
• Subject: biopsy / Clinical research/practice / diagnostic techniques and imaging / kidney (allograft) function/dysfunction / kidney injury/failure / kidney transplantation/nephrology / rejection
• ISBN: 111887014X, 9781118870143