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Clinical features and diagnosis of acute renal allograft rejection

Daniel C Brennan, MD, FACP
Tarek Alhamad, MD, MS, FACP, FASN
Andrew Malone, MB, BCh, MRCPI
Section Editor
Barbara Murphy, MB, BAO, BCh, FRCPI
Deputy Editor
Albert Q Lam, MD


Acute renal allograft rejection is a major cause of allograft dysfunction. Some kidneys do not regain function even with maximal antirejection therapy.

Even among patients who recover, acute rejection episodes can have a negative impact on long-term graft survival. Acute rejection is a major predictor of interstitial fibrosis/tubular atrophy (IF/TA), formerly called chronic allograft nephropathy, which is responsible for most death-censored graft loss after the first year posttransplant. (See "Chronic renal allograft nephropathy", section on 'Importance of acute rejection'.)

There has been a dramatic reduction in the incidence of acute rejection due to the introduction of potent immunosuppressive drugs in the past three decades. However, optimizing immunosuppression to both prevent allograft rejection and minimize drug toxicity, infection, and malignancy remains challenging.

A discussion of the clinical features and diagnosis of acute renal allograft rejection is presented in this topic review. The evaluation of renal allograft dysfunction and the treatment of acute rejection are presented separately. (See "Evaluation and diagnosis of the patient with renal allograft dysfunction" and "Treatment of acute T cell-mediated (cellular) rejection of the renal allograft" and "Prevention and treatment of antibody-mediated rejection of the renal allograft".)


Acute renal allograft rejection is defined as an acute deterioration in allograft function associated with specific pathologic changes in the graft. There are two principal histologic forms of acute rejection:

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Literature review current through: Nov 2017. | This topic last updated: Sep 22, 2017.
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