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Kidney Transplant Rejection –

By Yolanda Smith, BPharm

A kidney transplant is a valuable procedure that is able to dramatically improve the quality of life of many patients. However, not all kidney transplants are successful. This article considers the reasons behind rejection and the treatment options for those that have failed.

The success rate for a kidney transplant is relatively high and there are only a small number of kidney transplant rejections.

  1. 97% of kidney transplants are working a month after the procedure

  2. 93% of kidney transplants are working a year after the procedure

  3. 83% of kidney transplants are working 3 years after the procedure

  4. 54% of kidney transplants are working 10 years after the procedure

The signs and symptoms of kidney transplant failure can vary. Many patients report decreased function of the kidney and may feel uncomfortable, uneasy or ill. Flu-like symptoms such as chills, aches, nausea, cough, shortness of breath may also present. Rarely, patients report pain or swelling in the abdominal region, possibly accompanied by a fever.

Reasons for Failure

There are various reasons that a kidney transplant may fail but the most common reason for rejection is due to an immune response in the body. This occurs because the body of the recipient recognizes the antigens on the donor kidney as foreign and attacks them.

To prevent this reaction, anti-rejection medications are prescribed to suppress the immune system and allow the kidney to function in the recipient. However, even with the appropriate precautions, rejection can still occur.

Other factors that may contribute to the failure of a kidney transplant include:

  1. A blood clot that limits blood flow to the kidney shortly after surgery

  2. Fluid collection and pressure build up around the kidney

  3. Infection in the kidney that causes problems in kidney function

  4. Issues with donor kidney

Types of Rejection

Hyper-acute kidney transplant rejection occurs immediately after the transplant surgery. This is relatively rare in modern surgical practice, but may sometimes occur. The tissue should be removed immediately to avoid serious complications, such as death.

Acute rejection may occur anytime within the first three months of the transplantation procedure. All patients experience this to some degree but complete rejection occurs in less than 1 in 20 recipients.

Chronic rejection is the most common type of kidney transplant rejection and the reason for the majority of failures. It involves long-term damage to the kidney by the immune system that leads to failure more than a year after the transplantation.

Coping with Transplant Rejection

It is common for patients to feel shocked and disappointed if the transplant fails, particularly if it occurs shortly after the procedure. However, some other patients may feel relieved when the transplant fails, which often occurs if there were significant complications or adverse effects associated with the transplant.

While sometimes the transplant rejection can be linked to patient non-adherence of medications, in the majority of cases the rejection is out of the control of the individual. They should be aware that every effort was made to ensure the success of the transplant, but rejection can occur in some individuals regardless.

Patients will require dialysis once again, which can be difficult news and may contribute to psychological conditions such as depression. For this reason, it is important that they have access to a strong support network and are aware of possible future developments such as re-transplantation.


Approximately 20% of all kidney transplants are re-transplantations for patients who have previously had a kidney transplant.

Many patients begin the process of finding potential donors and getting on the waiting list as their kidney is failing and before they restart dialysis. This can help them to feel more in control of the process and their health.


Further Reading

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