At my last appointment with my transplant team, I learned the result of my second biopsy of my graft that has allowed me to live again for more than a year. Unfortunately, there are signs of rejection present in my new kidney. Still, the transplant team doesn’t seem stressed about it. What are the types of releases and why is this not a cause for concern in the short term for me? Let’s dig deeper into the subject, as much to reassure myself as to learn more!
What is transplant rejection?
Transplant rejection occurs when the transplant recipient’s immune system recognizes the graft as a foreign object and attempts to destroy it by attacking it. Without anti-rejection medication, the latter would be immediate after the transplant. For this reason, transplant recipients must take these drugs for the rest of their lives, or until the graft is rejected.
Graft rejection can still occur even if we take our anti-rejection medications. This is one of the swords of Damocles hanging over our heads, the other being the really higher risk of cancer than the general population.
The risk of transplant rejection depends on the type of transplant, the genetic match between the donor and recipient, and the general health of the transplant recipient. In the first year, the risk of rejection of a kidney transplant is 10 to 15%, according to some studies. I’m past that stage, but chronic rejection can happen at any time.
Regular follow-ups with the transplant team are used to prevent transplant rejection and to act quickly if it occurs. In my case, there was no sign of rejection of my kidney graft in my urine tests or blood tests. It was really at the biopsy that they found inflammation in the graft.
A transplant rejection does not mean that we will lose our graft. Depending on the type and if discovered in time, increasing anti-rejection medication to increase one’s immunosuppression (lowering our immune system) is normally enough to return to normal. Caught early enough, transplant rejection can be treated without any permanent injury to the graft.
Transplant rejection : The Three Types of Recipient VS Graft
1- Hyperacute rejection
This type of rejection occurs right away or within hours of the transplant. In this case, the body immediately rejects the organ. This rejection happens in a matter of minutes. It is caused by the patient’s immune system recognizing antigens in the graft as foreign.
This happens less often than it did before because more tests are done before transplants to ensure that the recipient’s body has not already built up resistance to the donor’s antibodies. If it is the case, the transplant will not be done to simply avoid this type of rejection.
2- Acute rejection
Acute rejection usually occurs within the first few weeks or months after transplantation. The body discovers the presence of a foreign/dangerous body (the graft) and attacks it. If this doesn’t happen in the first few months, acute rejection shouldn’t occur.
This type of rejection can be treated with steroids (cortisone) or higher doses of immunosuppressive medication. Without treatment, the graft will be destroyed within one or two weeks.
3- Chronic rejection
This type of rejection occurs slowly over time months or years after the transplant. The cells in the graft die naturally to be replaced by new ones, as it does with the rest of the body. In this case, the waste products it produces can be recognized by the recipient’s immune system as foreign.
If this is the case, it can cause a slow but constant attack on the source of this waste, i.e. the graft. The organ then suffers irreversible damage created by intensified inflammation. The latter sets in because of the attacks and the renewing of the tissues. Scars are then created. They can then block the supply of blood – and therefore oxygen – to the organ. Without blood, the organ eventually becomes necrotic. For more details on chronic rejection: https://www.youtube.com/watch?v=gAK20PxNVWI .
Chronic rejection is the main cause of organ rejection, and a new transplant may be necessary. Only half of transplanted kidneys are still functioning after 10 years. The average is higher for transplants that come from living donations (as in my case, thanks to my donor Frédéric :P). It is between 15 and 20 years.
Transplant rejection – Graft VS recipient
In the three types of rejection described above, the recipient’s body attacks the graft. The other category of rejection is when the graft attacks the donor’s body when it realizes that it is in an environment that’s not similar to it. This happens mostly for bone marrow transplants.
My Current Transplant Rejection
During my routine biopsy one year after the transplant, signs of trasplant rejection were found. They found signs of inflammation in the graft. My body is fighting against my new organ. As with any injury, it produces an immediate reaction of the body to heal it, which is called inflammation. Inflammation is also responsible for chronic transplant rejection when it occurs over time, as I wrote previously in this article.
All my test results are normal (except the biopsy) and my kidney function is normal. This tells us that the inflammation has not had time to create damage. My transplant team increased my anti-rejection medication. They expect that it’s going to be enough to end this episode of rejection. It was taken so early that there should be no consequences on the function of my graft.
The beginning of a preventable transplant rejection more than a worrying one
From what I understand, it’s not clear in the scientific community whether treating the type of inflammation they found during my biopsy improves the lifespan of the grafts. Taking no action does not always seem to lead to chronic rejection.
I guess it’s better not to take any chances! As long as we are not sure that treating does not have added value, doing it preventively can be a good idea. The risk of increasing my anti-rejection medication is that the BK virus might become active again in my body as it did last year (I’ll tell you about it soon) and that it will attack my graft. Increasing my immunosuppression also comes with other risks, including higher risks of cancers.
So we have a choice: increase my medication at the risk of awakening the BK virus and increase my risk of cancer, or keep it at the level where it is now and risk the beginning of chronic rejection. The choices of transplant life are fabulous 😛
Thinking about transplant rejection is quite stressful. One day, I may become as sick or sicker than I was before my transplant. I may have to go on dialysis to survive.
But hey, you never know, there are people who live 50 years with the same graft, let’s hope I am one of them! In any case, it seems that I am not in danger at the moment. Thank you to my body and my graft for allowing me to live a fairly normal life for a while!
See you soon,
Judith – The PKD Warrior
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