Symptomless acute renal transplant rejections. Occurrence six months or more after transplantation

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Abstract
A total of 22 cases of acute rejection episodes occurring 6 mo.-5 yr after renal transplantation were retrospectively reviewed for the presence of fever, graft tenderness, increase in blood pressure, declining urine output, falling urine sodium level, change in WBC [white blood cell] count and patient''s response to antirejection therapy. A total of 13 episodes were not associated with any of these symptoms or signs of an acute rejection episode; 7 episodes were associated with an increase in blood pressure alone and only 2 episodes were associated with fever. Nineteen rejection episodes were confirmed by biopsy. In 16 of these late-rejection episodes, the patient had complete or partial response to therapy. Acute rejection episodes can occur months to years after transplantation; patients are typically asymptomatic; many patients respond to therapy; and biopsy is often helpful in establishing the diagnosis.

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