Q: My sister underwent a kidney transplant 4 weeks ago. She is feeling fine. But I am worried about her reports. Her last report says Creatinine level of 1.1, Urea level of 48, TWC of 11900 and her cyclosprine level is 442. But in the previous report, which was done 5 days back was same except the urea level was 40. Does it signify any mild rejection?

A:Graft survival for all solid organ transplantation procedures is restricted by rejection of the graft by the donor’s immune system and constant effort is being made to induce a state of donor-specific tolerance in the patient so rejections will not occur. The current methods of diagnosing graft dysfunction are inadequate in that significant organ damage occurs prior to the establishment of a clinical diagnosis. Measurement of serum creatinine has been the most significant biochemical marker of acute rejection, but considerable tissue damage may occur prior to the serum creatinine becoming elevated. Due to this, histologic assessment of the allograft has therefore become the gold standard for the diagnosis of acute rejection. Renal graft rejection can be: Hyper acute - rejection of the graft within hours of the transplant; Accelerated acute rejection – this is a very early, rapidly progressive, aggressive rejection reaction occurring within the first week of transplantation. Acute tubular interstitial cellular rejection – this type is most common and usually occurs between 1-3 months after the transplant. Chronic rejection - slow and progressive deterioration in renal function characterized by histologic changes in the kidney. It is a major cause of kidney graft loss and occurs later than 2 years after transplantation. Please discuss with your doctor as he would be best placed to explain and advise.