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. |