Immunosuppression and Kidney Transplant

Kidney transplant is the treatment of choice for many patients with end-stage kidney disease, offering improved survival, better quality of life, and greater freedom compared with long-term dialysis. However, the success of a kidney transplant depends not only on surgical expertise and donor compatibility, but also on the careful and lifelong management of immunosuppression.

Immunosuppression in kidney transplantation is designed to prevent the recipient’s immune system from recognizing and attacking the transplanted organ. Because the immune system is highly efficient at identifying foreign tissue, unmodified immune responses can lead to acute rejection, chronic allograft dysfunction, and ultimately graft loss. Modern immunosuppressive regimens have dramatically reduced rates of acute rejection and significantly improved short- and medium-term graft survival. Kidney transplant recipients will need to take immunosuppression medication for life posttransplant.

“A goal in transplant is for our patients to achieve tolerance, where the immune system doesn’t try to reject the new organ, but is still able to fight off different infections,” says William Hoffman, MD, transplant nephrologist at UPMC Harrisburg and director of the living donor program at UPMC Harrisburg. “But, this is not yet a reality that we are able to achieve without immunosuppression medications. Rejection risk is higher closer to the time of transplant, typically in the first couple of months or a year after transplant, so we tend to give our patients more immunosuppression medication in the beginning of their posttransplant journey.”

Immunosuppression and Posttransplant Care

Dr. Hoffman recommends his patients to take their medications properly, including taking the right dose at the right time every day.

“That always helps to ensure a good outcome,” Dr. Hoffman says. “Patients should also get routine bloodwork done, that’s how we track how well the kidney is functioning after transplant. Having regular bloodwork also helps to avoid problems with the medications.”

Dr. Hoffman also recommends patients receive their recommended vaccines before and after their transplant to help reduce the risk of infections.

“These vaccines can help reduce how sick a patient can get,” Dr. Hoffman says. “Patients who are having signs or symptoms of infections, fevers, not feeling well, shortness of breath, or urinary problems, should alert their transplant team as soon as possible.”

Diagnosing Kidney Rejection

When a patient experiences kidney rejection, a physician may request a biopsy and take a needle into a piece of the kidney and look into a microscope, where they can see evidence of an immune response against the kidney and diagnose rejection. It is also possible to measure antibodies against the kidney in a patient’s blood.

“If a patient experiences rejection, a common misconception is that the kidney just fails, but usually we are able to treat rejection by giving the patient different forms of increased immunosuppression, usually in a few doses or treatments and that can recover kidney function so the kidney can then last for a longer time,” says Dr. Hoffman.

A Multidisciplinary Approach

The team at UPMC Harrisburg provides patients with education during each step of the transplant process, from evaluation to their regular posttransplant appointments. The team requires patients to have a support person in order to be added to the kidney transplant waiting list, and they are involved throughout the whole process. Care partners receive the same education as the patient, so they know how to help their loved one during the entire transplant process.

“At UPMC Harrisburg, we use a multidisciplinary approach with physicians, surgeons, transplant pharmacists, social workers, and transplant coordinators,” says Dr. Hoffman. “It’s very important to have a whole team in place to navigate any issues that a patient may have.”

To refer a patient, or for more information, please call 717-231-8700 or email transplanthbg@upmc.edu.