Organ Rejection

Organ rejection is a very specific problem that can occur after transplantation. Because the new kidney comes from another person, your child's immune system will recognize that the kidney is different and may try to attack it. If your child's immune system injures the kidney, this is called rejection.

Rejection does not necessarily mean that your child will lose the kidney. If detected early, most rejection episodes can be treated successfully.

The Four Types of Rejection


Hyperacute rejection occurs right after the blood supply is connected to the new kidney in surgery. This type of rejection rarely happens because the crossmatch test prior to surgery usually identifies antibodies that would cause this type of reaction.


Acute rejection usually occurs within the first six months after transplantation. During that time, we regularly draw blood from your child to monitor the level of creatinine, a protein released into the bloodstream as waste material from the muscles. Higher levels of creatinine in your child's bloodstream may indicate that the kidney is not doing a good job flushing waste material out of the body.

We make sure this is what's happening by taking a biopsy - inserting a needle into your child's kidney and taking a small sample of tissue. Looking at the biopsy under a microscope, we will be able to see injury to the kidney caused by the immune system. Your child will be asleep for this procedure and may need to stay in the hospital overnight afterwards.

It is common to see at least one rejection episode about two to three months after surgery. Don't get discouraged. This is why we check your child so closely with lab work and other tests.


Subclinical rejection is where very early rejection is detected with a kidney biopsy before there is enough damage to cause the creatinine in your child's bloodstream to increase. Early treatment for this condition can improve your child's chance of keeping the new kidney for the long term. To detect this, we do a needle biopsy of the kidney three different times: early after transplant, between 6 and 12 months after transplant and between 12 and 24 months after transplant.

If acute or subclinical rejection is diagnosed, we will start anti-rejection therapy. Usually we start with a high dose of prednisone, which is a steroid that helps suppress the immune system so that your child's body will not reject the kidney. The prednisone is given through an IV for three days. If prednisone therapy does not work, other medications can be used.


Chronic rejection occurs slowly over time. In this case, the kidney develops a lot of scar tissue, which is the result of injury from the immune system's response over a long period. Chronic rejection can be more difficult to reverse, and our care focuses on maintaining kidney function for as long as possible. Your child may not require dialysis or another transplant for years.

The possibility for rejection is greatest soon after transplant. But at any point your child's immune system may try to reject the kidney.

For the new organ to live successfully in your child's body, we must give your child medicines that suppress the immune response.

To prevent this from happening, your child may need to take medicines for as long as the kidney is in place.

The most common rejection symptoms include:

  • Fever
  • Tenderness over the kidney
  • Elevated blood creatinine level
  • High blood pressure

Every child is different and some or none of these symptoms may occur during a rejection episode.

Your child's transplant team will instruct you on whom to call right away if any of these symptoms occur.

Not Following Instructions (Non-Adherence)

When a patient or family is not following the transplant team's instructions, we use the term non-adherence. This can mean not taking medications properly, not getting blood draws on time or not getting the medical follow-up that is needed.

Some transplants fail because of non-adherence on the part of patients and families.

Remembering to take medicines is very important.

At the time of transplantation, your child will receive medicines to suppress the immune system. The type or combination of medicines depends on whether the kidney comes from a living donor, a related living donor or a deceased donor.

You and your child must be committed to taking the prescribed doses of these medicines on a strict daily schedule. Not following all medical instructions can result in kidney failure for your child.

While it is important that your child learn responsibility for taking their own medications, children and teens will often forget or delay doing the things that they need to do. You must supervise your child's medication schedule for the sake of your child's kidney and overall health.