Acute Rejection, Kidney

General Principles

Most episodes of acute rejection occur within the first year after transplantation. The low incidence of acute rejection today necessitates a careful search for inadequate drug levels, nonadherence, or less common forms of rejection (such as antibody-mediated rejection or plasma cell rejection). Late acute rejection (>1 year after transplantation) is often a result of inadequate immunosuppression or patient nonadherence.

Definition

An immunologically mediated acute deterioration in renal function associated with specific pathologic changes on renal biopsy including lymphocytic interstitial infiltrates, tubulitis, and arteritis (cellular rejection) and/or glomerulitis, capillaritis, and positive staining of the peritubular capillaries for the complement component C4d (antibody-
mediated rejection).

Epidemiology

Kidney allograft rejection currently occurs in ∼10% of patients. Patients who do not receive induction therapy have a 20%–30% incidence of acute rejection.

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