Immunosuppression and Rejection

Your immune system is important in protecting your body from infection and cancer. 
T cells from your immune system are always circulating in the blood and identifying foreign tissue such as a newly transplanted organ. Human Lymphocyte Antigens (HLA) are molecules that provide a unique signature on all your cells, telling the
T cells that the cells in your body are your own. When you receive an organ transplant, the T cells of the immune system in your body will notice that the transplanted organ does not have the same HLA antigens as the rest of your body. The T cells and other cells of your immune system will then try to destroy the transplanted organ

What is Rejection?

Your body's immune system is designed to seek and destroy any foreign object that it finds in your body, such as a cold virus, a flu virus, or a transplanted organ. The process of destroying the transplanted organ is called rejection. Rejection occurs as your body's immune system responds to the presence of the transplanted kidney and/or pancreas. However, in transplant recipients, this immune response needs to be suppressed to protect the transplanted organs.

There are several types of organ rejection. These types are described by the kind of cells causing the rejection, when the rejection occurs, and by the severity of the rejection.

  • Acute Cellular Rejection: Is the most common form of rejection is. In this type of rejection, the body's blood cells identify the pancreas as foreign and begin mounting an army of cells to attack the transplanted organ. Although acute rejection can happen at any time, about 15 to 25% of pancreas acute rejection occurs within the first three months after transplant. Acute rejection can be treated. Having acute rejection does not mean that you will lose your transplanted organ, but it is very important that rejection is diagnosed and treated as soon as possible. To help detect rejection, you should have your blood tests completed routinely as requested by your transplant center, have routine follow-up visits with your doctor, and report any symptoms you are having to your transplant center.
  • Chronic Rejection: Occurs if the rejection process does not completely resolve, or if it continues slowly over time. Chronic rejection is more difficult to treat because of more permanent changes in the kidney tissue and eventually will loose all function.

How Do I Know I am Rejecting My Pancreas?

Measuring the pancreas function tests regularly and watching the pattern of the results can help your doctor decide what is happening to your kidney. Measuring your fasting blood glucose level in the morning may also help detecting is the pancreas is working well.

If your blood test results are out of the normal range, your transplant physician or transplant coordinator will discuss the results with you. Some abnormal lab values may be acceptable as you recover from transplant or a related complication and should improve over time.

What are the Symptoms of Rejection?

After you leave the hospital, your blood tests will be monitored less frequently. If rejection occurs, you may experience some mild symptoms, although some patients may continue to feel fine for a while. The most common early symptoms include: fever greater than 100° F or 38° C, increased pancreas function tests, tenderness over the graft and later even increased glucose levels. Additionally, your doctor may want you to have a kidney biopsy to confirm that your symptoms are caused by rejection.

What is a Kidney Biopsy?

Although your symptoms and pancreas function test results help diagnose rejection, a biopsy confirms that the organ is being rejected. A small piece of tissue is examined under a microscope for signs of rejection. The biopsy procedure is usually done as an outpatient or short-stay hospital procedure.

If you receive a combined pancreas and kidney, both organs will reject at the same time in 80% of the cases. In such instances, the kidney can be biopsied to detect the rejection. Treatment will be directed to treat both organs. If you only received a pancreas transplant, biopsies are more difficult to obtain, generally your surgeon will measure other blood levels to have more information about the type of rejection and may treat you without having a confirmation by biopsy.

To prepare for the biopsy, the area where your kidney was placed will be cleaned with an antiseptic solution. You will be given an injection of a local anesthetic, or numbing medicine, into the area where the biopsy will be done.

An ultrasound is usually done to determine the best place to insert the biopsy needle. After the area is numb, the doctor will advance a special needle into the kidney to take out a small piece of tissue. It may look like a short piece of string. The actual biopsy only takes a few seconds. The tissue is placed into a special solution and taken to the pathology lab to be processed and viewed under the microscope.

Following a kidney biopsy, you will be required to rest in bed for two to four hours. Your nurse will monitor you for complications related to the biopsy through your vital signs, physical assessment, blood tests, and /or any physical complaints. Your urine will be checked for the presence of blood (hematuria). Most patients feel fine after a kidney biopsy.

Call the transplant center immediately if your urine becomes bloody or if you pass any clots in your urine.

Can I Have a Pancreas Biopsy?

Pancreas biopsy is indicated in very few occasions. There is an increased risk of bleeding from pancreas biopsy and other complications. This is why most surgeons don't like to perform a biopsy of the pancreas. If you received a combined kidney and pancreas transplant, in 80% of the cases the organs reject at the same time, and doing a kidney biopsy only can make the diagnosis of rejection.

To Decrease My Risk for Rejection and To Monitor Symptoms of Rejection, I Should:

  • Know and understand the signs and symptoms of kidney rejection
  • Take all my medications as prescribed
  • Make sure I always have a supply of my medications
  • Stay in regular contact with my transplant coordinator or transplant team for any changes in my immunosuppression
  • Have my blood testing done as instructed
  • Follow-up on my blood test results with my transplant coordinator
  • Call my transplant coordinator or physician if I think I am experiencing any symptoms of rejection
  • Avoid excessive alcohol, recreational/illegal drugs, and any herbal remedies or supplements