Post Transplant Complications

The kidney is the most frequently transplanted organ in the world, but it is not free of complications. 

The complications might be related with the transplantation it self and might be related with the immunosuppressive medications. 

The important post transplant complications are: 

Transplant rejection: Even with good tissue match the immune system may react against a healthy kidney anytime because it is foreign to the body. Less than 50% of all kidney recipients experience at least one rejection episode, most of which can be controlled. 

Rejection usually causes symptoms like fever, pain, fall in urine output and tenderness over the transplant site, but these are rare now a day with the development and use of potent immunosuppressive drugs and rejection may occur without these symptoms. 

There are two types of rejection including acute (sudden) and chronic (gradual). A drastic rise in creatinine may indicate acute rejection, especially in the first year following transplant. It needs augmentation in immunosuppression and should be dealt very seriously. 

Chronic rejection usually presents with slow and progressive rise in urea and creatinine. 

Other than rejection graft dysfunction may occur due to the recurrence of the original disease, obstruction of the ureter at the site of implantation in the bladder or because of high blood levels of Cyclosporine. Due to immunosuppressive drugs patients are more prone to develop all types of infections such as tuberculosis, hepatitis B and C, Pneumonia and urinary tract infection. 

Cytomegalovirus, Herpes, and fungal infections which are otherwise uncommon, are frequently seen in transplant population. The risk of these infections is highest at the initial postoperative period because of high immunosuppression at that time. 

Side effects of the drugs:

1. These drugs can cause Diabetes and hypertension in some patients who may require appropriate treatment.
2. Liver dysfunction may be caused by Cyclosporin and Azathioprine.
3. Steroids, an essential postoperative medicine, can cause stomach ulcers, and weakness of the bones.
4. These immunosuppressant drugs also predispose the patient to some types of skin, stomach and brain cancer.

Note: 
In spite of all these complications which are mentioned, kidney transplantation is the treatment of choice for ESRD patients because quality of life is much better after successful operation than hemodialysis and peritoneal dialysis. 
Only some of the transplant patient may develop serious complications with the majority being treatable.