Common Signs & Symptoms That Your Body is Rejecting Your Transplanted Kidney or Heart

Common Signs & Symptoms That Your Body is Rejecting Your Transplanted Kidney or Heart

Common Signs & Symptoms That Your Body is Rejecting Your Transplanted Kidney or Heart

A person living with a transplanted organ can live a healthy and normal life.

However, to increase your chances of long-term success, experts say that immunosuppressants (anti-rejection medications) must be taken every day as directed.1

“A transplanted organ is seen as a foreign object—or an ‘unwelcome visitor’—by your body,” says Nikhil Agrawal, MD, a nephrologist with Beth Israel Deaconess in Boston. “That is why your body’s immune system works hard to react against—or ‘reject’—the transplanted organ. Immunosuppressants suppress your body’s immune system and prevent rejection.”

The signs and symptoms of rejection could differ based on your transplanted organ. Below are a few things to look out for if you are a kidney- or heart-transplant recipient.

Kidney-Transplant Rejection—Things to Look Out For

For kidney-transplant recipients, the five-year survival rate of the transplanted kidney is more than 80%.2 The less-fortunate news is that, in some cases, transplanted kidneys do not survive—or do not last as long as others do.

One common reason for this is your body’s refusal to accept the donated kidney. This rejection can occur shortly after the transplant or many years later. Depending on the rejection changes in the kidney, it is called “acute” or “chronic.” Acute rejection is when the process started recently while rejection that has been going on for some time is called chronic.3

Keep in mind that if you are told by your doctor or healthcare team that you are having a “rejection incident” or “rejection episode” it does not mean your new kidney is not working or that it will be completely rejected.

It does, however, mean that your doctor or kidney team will need to find strategies to protect your new organ. This could mean changing or modifying your anti-rejection medicine.

Kidney rejection, especially when mild, oftentimes does not have symptoms or is not caught during blood or urine tests.

Therefore, Dr. Agrawal encourages you to keep up with the routine tests prescribed by your transplant team.

The most common kidney-rejection signs and symptoms to look out for include:

  • Fever
  • Tenderness over the kidney-transplant site
  • Flu-like symptoms (chills, nausea, vomiting, diarrhea, body aches, headache)
  • Fatigue
  • Swelling
  • Very high blood pressure
  • Weight gain4

“If any of these symptoms occur, be sure to immediately notify your transplant team,” says Dr. Agrawal.

Heart-Transplant Rejection—Things to Look Out For

Just like transplanted kidneys, transplanted hearts can also be rejected by your immune system.

For heart-transplant recipients, the five-year survival rate of the transplanted heart is 70%.5

Heart rejection can also occur without symptoms.6 Call your doctor immediately, however, if you experience any of these symptoms of heart-transplant rejection:

  • Chest pain
  • Shortness of breath
  • Dizziness
  • Irregular heartbeat
  • Fever
  • Your incision becomes red, swollen, and painful, or it oozes blood7

The Role of Anti-Rejection Medications

To help fight off your body rejecting your new organ, you will be prescribed anti-rejection medications. There are many types of anti-rejection medications, and you will remain on them for the life of your transplanted organ.

Common anti-rejections medications include:

  • Calcineurin Inhibitors:
    • Tacrolimus (Prograf®) and generics
    • Tacrolimus long-acting (Astagrat XL®)—There are no generics for this drug
    • Tacrolimus long-acting (Envarsus XR®)—There are no generics for this drug
    • Cyclosporine (Sandimmune®) and generics—Make sure generic does not say “modified”
    • Cyclosporine modified (Neoral®)
  • Antiproliferative agents:
    • Mycophenolate mofetil (CellCept®and generics
    • Mycophenolate sodium (Myfortic®)
  • mTOR inhibitor: Sirolimus (Rapamune®) and Everolimus(Zortress®)
  • Co-stimulation Blocking infusions: Belatacept (Nulojix®)
  • Steroids: Prednisone

Transplant recipients may experience side effects from their anti-rejection medications. If any of the side effects occur—or do not go away—be sure to immediately notify your transplant team.

Dr. Agrawal mentions that you should not stop or modify the medications without first discussing with your transplant team.

“At every appointment, discuss with your transplant physician what medications you should take—and how you should take them—as these may change, especially in the first year,” says Dr. Agrawal.

Tools to Monitor Your Transplanted-Organ’s Health

To reiterate: Rejection can occur without any symptoms.

In addition, the symptoms of rejection could be due to a condition other than rejection.

Therefore, Dr. Agrawal emphasizes that surveillance with lab tests is important in optimizing the life of your transplanted organ.

Lab tests evaluate the function of the transplanted organ and identify possible problems.  Your doctor may need to perform a biopsy [i.e., removal of a small piece of tissue from the organ which can be examined under the microscope) to ensure that there is not rejection or some other problem with your kidney function

For kidney-transplant recipients, there is a new surveillance biomarker known as donor-derived cell-free DNA (dd-cfDNA).

The National Kidney Foundation (NKF) says that dd-cfDNA “… oftentimes detects pathology prior to conventional biomarkers like [serum creatinine].” The NKF adds that “…[dd-cfDNA] is already in use in the vast majority of transplant centers.”8

When a kidney or heart is transplanted into a recipient, there is a continuous release of dd-cfDNA fragments from the donated kidney or heart. This dd-cfDNA circulates though the transplant-recipient’s blood.

Measuring dd-cfDNA fragments from the donor organ allows for early identification of injury to the transplant that may be caused by rejection, infection, dehydration, or other changes.

AlloSure® as a Tool to Monitor Your Transplanted-Organ’s Health

AlloSure measures dd-cfDNA levels that circulate within the blood of transplant recipients and rise when there is organ injury.

“By using AlloSure, you doctor can more accurately determine active injury of your transplanted kidney or heart,” says Dr. Agrawal. “Using AlloSure gives your doctor an extremely useful measurement of your transplant’s health and could also help you avoid an invasive and unnecessary tissue biopsy.”

To learn more about AlloSure, click here.

For heart-transplant recipients, there is HeartCare, which is a comprehensive heart-rejection-surveillance solution that combines AlloSure (dd-cfDNA) and AlloMap® (gene expression immune activity).

To learn more about HeartCare and AlloMap, click here.

Blood Tests (Labs) That Monitor Your Transplanted-Organ’s Health

Your doctor will order regular labs to help monitor the health of your new organ. These labs may include surveillance options like AlloSure or AlloMap (HeartCare).

RemoTraC® is a service that brings a phlebotomist to your home to draw your blood for a panel of standard transplant labs, which—in addition to AlloSure or AlloMap surveillance tests—include:

Kidney Transplant Labs

  • Complete Blood Count
  • Anti-rejection-med levels (eg., Tacrolimus, Sirolimus, Cyclosporin, Everolimus)
  • Urinary Protein/Creatinine Ratio
  • Complete Metabolic Profile + Mg + Phos
  • Viral PCR (BK/CMV/EBV)
  • Urinary Protein/Creatinine Ratio

Heart Transplant Labs

  • Complete Blood Count
  • Anti-rejection-med levels (eg., Tacrolimus, Sirolimus, Cyclosporin, Everolimus)
  • BNP
  • Comprehensive Metabolic Panel + Mg + Phos
  • Viral PCR (BK/CMV/EBV)

If you are a kidney- or heart-transplant recipient who would like to learn about at-home lab services through RemoTraC, ask your doctor or sign up online by clicking here.

Always seek the advice of your physician or medical team with any questions you may have regarding your specific medical condition. The information is not intended or implied to be a substitute for professional medical advice from your healthcare provider.

1 National Kidney Foundation 
3 American Kidney Fund
4 American Kidney Fund 
5 Harvard Health Publishing
6 Mayo Clinic
7 Harvard Health Publishing
8 National Kidney Foundation