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Kidney Transplant

Followup

Rejection Problems

While the holidays were a time of good health and gratefulness that 1997 had ended on a much more positive note than it had begun, trouble was looming on the horizon for Sam as 1998 dawned. Things had been going well. Creatinine had been in the 1.7 to 2.0 range and anti-rejection medications had been progressively reduced to levels appropriate for keeping the transplant functioning well, but avoiding or decreasing some of their many side effects.

Since lab results were stable and Sam was feeling well, his primary nephrologist, who had assumed his care again last September, had extended follow-up visits to every four weeks. No blood tests were drawn from Christmas until Sam returned in late January for a routine follow-up appointment. He was feeling well and had not noticed any signs of rejection, but blood tests showed a problem. The creatinine in the blood had climbed from 1.8 to 3.4. The BUN level was up to 47. Blood pressure was high.

The nephrologist had weaned Sam down on cyclosporine A (Neoral®) during fall of 1997 to avoid toxicity to the nephrons in the transplanted kidney, a problem that can occur if levels of the anti-rejection medication stay too high. He had tested blood levels until the range was 200 to 250, making sure the creatinine remained stable in the 1.7 to 2.0 range. Seeing the creatinine at 3.4, the nephrologist assumed Sam might be having an acute, or short-term, rejection episode. He acted to assess and treat the problem.