A 47-year-old man with a history of chronic renal failure presents to the clinic for a follow up after a kidney transplant three weeks ago. His surgery was successful and his transplanted kidney started producing urine right after the operation. However, today his urine output drops and his serum creatinine begins to rise. There is no fever or dysuria. Urinalysis shows no abnormality. Biopsy from the transplanted kidney shows cellular infiltrate of cytotoxic cells (CD8).
What is the most likely diagnosis of this condition?
This is an acute rejection. It happens in the first three months after transplantation and is caused by discrepancy between human leukocytes antigen of the host and the graft. It is mediated by cytotoxic cells.
Hyperacute rejection is very rare now due to advanced tests prior to tissue transplantation. It is caused by pre-formed antibodies against the donor’s kidney cells. It occurs during the surgery or minutes to few hours after the transplantation and leads to complete destruction of the transplanted kidney.
Chronic rejection occurs months or years after the transplantation and caused by scarring within the transplanted kidney. It can be prevented by regular visits with laboratory tests.
Other options are just distractions.
The correct answer is C