By Dr Ananya Mandal, MD
A kidney transplant is a major operation. There are complications associated with most major operations that may occur with kidney transplant as well. These include pain, delayed wound healing, bleeding and risk of infections. One of the most dreaded complications, however, is rejection reaction or the body’s rejecting the newly donated kidney.
Complications of kidney transplant include rejection, side effects of immunosuppressants and so forth.
The immune system of the body perceives the kidney as a foreign object or tissue and mounts a reaction against it. This may lead to massive damage to the new kidney. Early signs of rejection include fever and soreness at the site of the new kidney and reduction in the amount of urine production. To prevent rejection reaction immune suppressing medications are prescribed right after the operation.
Rejection may be of various types depending on their timing.
Hyperacute: occurs within minutes of insertion. This is rare these days due to matching of tissues before donation. This means the donated kindey should be removed immediately.
Accelerated: This occurs within a few days in patients previously sensitised. There may be fever, swollen new kidney and high rise of levels of creatinine in blood. High dose steroids are given to combat this but may fail and removal may be needed.
Acute cellular rejection – This occurs in a quarter of all patients usually in 1-3 weeks but can occur up to 12 weeks. There may be fluid retention, rising blood pressure and rapid increase in blood creatinine.
Chronic rejection – In this type there is a gradual rise in serum creatinine and excretion of protein in urine along with high blood pressure. This type of rejection is not corrected by increasing immunosuppression therapy.
Side Effects of Immunosuppressants
Complications are also associated with the use of immune suppressing medications like azathioprine, ciclosporin, mycophenolate mofetil, sirolimus, tacrolimus, or prednisolone.
Immunosuppressants work by diminishing the ability of immune cells to function. These can weaken the immune system and may make the person vulnerable to infections.
Steroid drugs have a host of side effects like:
Over long term immune suppressants may also raise risk of certain cancers. When used over time, these drugs may also cause liver or kidney damage in a few patients.
Early complications of kidney transplant
Early complications include risk of abscesses within the abdominal walls. This is more likely in old, obese and diabetic patients.
Bleeding is another common complication immediately after surgery. Bleeding in uerine or hematuria may also be seen in some patients.
A major abdominal surgery weakens the abdominal muscles and may lead to a risk of abdominal hernias over the site of the incision called incisional hernia. Obese, diabetics, those with rejection are more at risk.
Some patients may develop infectious tracts or canals called urinary fistulae.
There is a risk of post-operative formation of blood clots or arterial thrombosis. These may get dislodged from the operative site and travel up to the lungs or brain leading to life threatening complications.
Late complications of kidney transplant
Late complications include narrowing of the ureters and obstruction to flow of urine from kidney into the bladder. This is called ureteric stenosis.
Pyelonephrritis or infection of the kidneys after surgery is another complication to be watching out for.
Some infections are common especially due to use of immunosuppressant mediations. These are termed opportunistic infections and include herpes simplex infection in the first four weeks and then cytomegalovirus infection. Fungal and bacterial infections are also seen.
Kidney stones may be transplanted with the donor kidney or may form later in the new kidney. There may be manifestations of blood in urine (hematuria), infections and obstruction.
Renal artery stenosis or narrowing of the renal arteries is a late complication. There may be development of other blood vessel abnormalities like arteriovenous fistulae and pseudo aneurysms (balloon like swelling of segments of the renal arteries). Some patients may also develop lymph channel abnormalities called lymphoceles.
Over long term there may be a risk of cancers of skin or lymphomas. This could be due to the use of immunosuppressant mediations. Common cancers include Kaposi sarcoma, kidney cancer and in women cervical cancer.
Heart disease like high blood pressure, high cholesterol etc. are common after kidney transplant.
Recurrence of the original kidney dysfunction that damages the new kidney is another complication of kidney transplant.
Reviewed by April Cashin-Garbutt, BA Hons (Cantab)