What is transplant rejection?

Rejection is your body's way of not accepting the kidney transplant. Although rejection is most common in the first six months after surgery, it can occur at any time. Fortunately, the transplant team can usually recognize and treat a rejection episode before it causes any major or irreversible damage. It is very important for you to continuously take your medications as prescribed and have your blood work drawn as scheduled.

What are the warning signs of possible rejection?

It is vital for you to be aware of the possible signs of kidney rejection. If you think you are experiencing any of these symptoms, contact the transplant team immediately:

  • Increase in serum creatinine
  • Fever higher than 100 degrees Fahrenheit (38 degrees Celsius)
  • "Flu-like" symptoms: chills, aches, headache, dizziness, nausea and/or vomiting
  • New pain or tenderness around the kidney
  • Fluid retention (swelling)
  • Sudden weight gain greater than two to four pounds within a 24-hour period
  • Significant decrease in urine output

How is rejection identified?

The transplant team will be able to determine if kidney rejection is present by performing scheduled protocol kidney biopsies at approximately three to six months and at one year post-transplant as a diagnostic screening tool, or if you are experiencing any of the warning signs and symptoms of rejection listed above. If the transplant team thinks that you may be having problems with your kidney, the following tests may be ordered:

  • Repeated blood work
  • Renal ultrasound to check blood flow to the kidney
  • Kidney biopsy

What is a kidney biopsy?

A kidney biopsy is a procedure that involves taking a small sample of kidney tissue from the transplanted kidney so that it can be tested to see if rejection is present. A kidney biopsy can be performed by an interventional radiologist or by a transplant team physician in an outpatient setting or in the hospital.

In order to take a biopsy, the skin above your kidney is numbed with medication and a small nick is made in the skin to allow a small needle to pass through to your kidney. Several kidney tissue samples will be collected. The tissue samples are examined under a microscope to establish a diagnosis. The biopsy procedure generally takes between 20 and 30 minutes. You are required to lie flat for two hours following the procedure to prevent bleeding.

How is rejection treated?

If a diagnosis of rejection is made, your doctor will prescribe medication to treat the rejection and prevent further complications. You may be admitted to the hospital for three to five days for treatment or be treated for three days in the outpatient setting. Treatment is dependent on the severity of the rejection and is determined by your doctor. The usual treatment is to give higher doses of anti-rejection medication.

Last reviewed by a Cleveland Clinic medical professional on 03/20/2019.


  • National Kidney Foundation. When a Transplant Fails. (https://www.kidney.org/transplantation/transaction/TC/summer09/TCsm09_TransplantFails) Accessed 5/9/2019.
  • American Kidney Fund. Life after transplant. (http://www.kidneyfund.org/kidney-disease/kidney-failure/treatment-of-kidney-failure/kidney-transplant/life-after-transplant/) Accessed 5/9/2019.
  • UNOS, Transplant Living. Preventing rejection. (https://transplantliving.org/after-the-transplant/preventing-rejection/) Accessed 5/9/2019.

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