Complications
Conditions associated with transplantation and immunosuppression:
- acute and chronic rejection
- acute rejection - this occurs 3-6 months after transplantation; features include rising serum creatinine (also occasionally graft pain and fever); graft biopsy reveals tubular damage and an immune cell infiltrate; treatment options include high-dose corticosteroids
- chronic rejection - occurs >6 months after transplantation; gradual increase in serum creatinine and proteinuria. Graft biopsy reveals fibrosis, vascular changes and tubular atrophy. Chronic rejection is not responsive to increased immunosuppression
- acute tubular necrosis
- thrombosis
- opportunistic infections
- hypertension - occurs in more than 50% of transplant patients; causes include diseased native kidneys, graft dysfunction or immunosuppressant drugs
- cyclosporin toxicity
- increased risk of malignancy - particularly, lymphoproliferative disorders such as non-Hodgkin's lymphoma and squamous-cell skin carcinoma
Conditions that can recur in the transplanted kidney:
- mesangiocapillary glomerulonephritis
- focal segmental sclerosis
- IgA nephropathy
- Goodpasture's syndrome
- vasculitides
Reference
- Thiruchelvam PT, Willicombe M, Hakim N, et al; Renal transplantation. BMJ. 2011 Nov 14;343:d7300.
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