This is a TransplantLyfe educational panel in partnership with CSL Behring discussing kidney rejection.
Kidney rejection is the body’s immune system identifying a foreign threat. There are different kinds of rejection , including acute cellular rejection, which happens mostly in the first 3 months after transplant where the body identifies a threat. This occurs in 10-15% of patients and is 99% treatable. Antibody mediated rejection is the immune system recognizing the specific foreign target as the transplanted organ and attacking it. This is rarer and more difficult to treat. People who have antibodies directed against the transplanted organ present in their bodies are at risk for antibody mediated rejection. Chronic rejection is the inevitable fate of nearly all kidneys, eventually, as years of the immune system causing scarring to the kidney makes the organ fail.
Mary shares her experience with episodic rejection. She was born with a condition where her kidneys never fully formed, and she received her first transplant at age 5. That kidney failed when Mary was 11 years old, at which point she received her second kidney transplant from a deceased donor. A few months later, she had acute rejection and was admitted to the hospital for treatment. Fortunately, she has lived 27 years with the second transplant. The average life of a transplanted kidney from a deceased donor is 10 years.
There are some symptoms to be aware of that are indicative of rejection. Acute rejection happens usually in the later part of the first 3 months and can be diagnosed by assessing creatinine lab values from an outpatient biopsy which measures the function of the kidney. It is recommended to avoid crowds in the first few months to prevent infection because a suppressed immune system can lead to a rejection episode. Other types of rejection are not as immediate and may occur in the following years after a transplant.
During chronic rejection, scarring occurs over time from the immune system fighting the transplanted kidney. The immune system cannot be shut down completely due to infection risk, so there can be a slow progression of the creatinine levels going up on blood tests reflecting a decrease in kidney function in the transplant. Ultimately, a patient may need a biopsy to confirm the diagnosis of chronic rejection. The biopsy determines whether there are immune cells infiltrated in the kidney and which type of rejection may be occurring – acute or chronic. There are no proven treatments to stop chronic rejection, but it can be slowed sometimes by changing and adjusting medications. If there is sufficient or rapid loss of transplant function, this may be a time to start conversations about getting the next transplant.
Overall, it is important for a patient to be involved in making the best decision for their care together with their care teams. Mary is seen at her transplant center 3 times a year, and she is also followed by a nephrologist. She stresses the importance of collaboration with her care team (nephrologists, surgeons, coordinators, etc.) and the value of self-advocating. In addition to the relationship with the care teams, it is also important to be open and share information about your health with family and friends to provide support for both the physical and mental burdens of dealing with a transplant.
Advice Mary would give to other patients: live your life to the fullest and do not be defined by your condition. Do not be afraid and live a life of restriction because of fear of rejection. Find the balance of living while being cautious. Life has challenges — whether you have health issues or not — and it’s about how we overcome them and continue to enjoy the gift of life to help others.
Listen to the full webinar and learn more about these conversations and information about life with kidney transplant.
This and future webinars can be found on transplantLyfe.com.
Panelists
- Dr. Casey McCune, surgical director of pancreas transplant programs
- Mary Wu, a two-time kidney transplant recipient and Lyfebulb patient ambassador advocating for those living with transplants
Moderators
- Dr. Karin Hehenberger, CEO of Lyfebulb and a recipient of both pancreas and kidney transplants