Hyperacute Due to ABO and HLA incompatibility due to existence of antibodies against transplant antigens and should never happen. Thrombosis, complement activation and organ failure immediately intra operatively. Acute: Before 3 months, worsening renal function, fever, localised pain. Biopsy done (easier as kidney in pelvis) . Give steroids, OKT3, Anti thymocyte globulin. Responds to increased immunosuppression. Acute rejection is mainly T cell mediated which is the focus of the immunosuppressive drugs Chronic: After 3 months, fibrosis and inflammatory cells. Does not respond to immunosuppression. The differential is Ciclosporin nephrotoxicity which causes raised creatinine and may warrant a renal biopsy.
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Transplant and organ rejection
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