In this section
Rejection episodes usually occur after the first week and are
associated with lymphocyte invasion of the graft (acute rejection).
Humoral-mediated rejection (antibodies to the graft) occurs in the
first week (hyperacute rejection) but is rare because the
recipient's serum is screened for antibodies in the crossmatch
before the transplant
There is no effective treatment for hyperacute rejection but the
common acute rejection episode can usually be reversed by an
increase in immunosuppression
A confirmed rise in serum creatinine of
0.02 mmol/l or more is taken as a sign of
rejection if the rise cannot be explained on other grounds. With
moderate and severe rejection episodes the urinary volume falls,
the blood pressure rises, body weight increases, and there may be
fever. High fever however is more likely due to infection.
For succesful transplantation, rejection and infection have to
be sorted out promptly - results of investigations
must be obtained quickly and appropriate therapeutic measures
started without delay.
A routine Transplant Biopsy (as per Biopsy Protocol) is often
carried out 3 months after transplantation to assess rejection
activity which may not otherwise be clinically apparent.
Usually the serum creatinine falls after the first or second
300 mg IV/m2 Methyl Prednisolone daily intravenously, given over
30 minutes, for 3 days.
This treatment is used if oral prednisolone cannot be taken or if a
2nd rejection episode occurs soon after an episode which partly
responded to oral prednisolone.
Again the serum creatinine usually falls 24 hours after the first
or second dose.
OKT3This is a murine monoclonal antibody which
causes rapid lysis of T3 lymphocytes. It is given for rejection
episodes unresponsive to steroids.Protocol for Administration of OKT3:-
Acute pulmonary oedema in volume overloaded patients may occur
with the first dose of OKT3. Ensure the patient is not volume
overloaded by clinical examination and if necessary by chest x-ray.
The weight of the patient should be the "dry" dialysis weight. Use
lasix to promote a diuresis, restrict fluids and dialysis may be
required. Ensure patient's temperature does not exceed 37.8ﾰC -
give paracetamol if necessary. Ensure availability of Oxygen,
Adrenalin, and Hydrocortisone.
Report:Over/Under infusion of drug
Increase in temperatureObserve:IV site
Skin condition (rash)
* Daily control of the blood count - serum levels of T-cells
* Sterile procedure when drawing up and attending to CVC infusions.
2 persons non-touch technique when peripheral IV in-