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What is the reason for acute rejection after a kidney transplant?

Q: I am 26 years old. I underwent kidney transplant 9 months ago. Now my creatinine is 3.8. Biopsy says it is acute cellular rejection with borderline changes of vascular rejection. I am taking Pangraf - 6mg/day (3-0-3), Rapamune - 3mg/day, Prednisolone - 15mg. My Pangraf level is 4.3 and Rapamune level is 2.43. Is there any possibility for my creatinine to get down to normal range? What kind of diet should I take? My donor was not blood related.

A:I would expect you to be following with a nephrologist. The acute rejection needs to be treated with intravenous methylprednisolone and vascular rejection usually requires thymoglobulin. I guess you would have received either or both of these drugs to try reversal of the process of acute rejection. A usually 70-80% of acute rejection show reversal of the acute rejection. Other immunosuppressive drugs like rapamune and pangraf and steroids are also increased to prevent further rejection. In absence of detailed allograft biopsy report, it is not possible to comment on whether your creatinine will get down to normal. Your nephrologist will have a better understanding of your case and you should discuss it with him/her. Your diet modifications will depend on the status of kidney functions.


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