A client received a kidney transplant 2 months ago. He’s admitted to the hospital with the diagnosis of acute rejection. Which of the following assessment findings would be expected?
A. Hypotension
B. Normal body temperature
C. Decreased WBC count
D. Elevated BUN and creatinine levels
Correct Answer: D. Elevated BUN and creatinine levels
In a client with acute renal graft rejection, evidence of deteriorating renal function is expected. In renal transplantation matching of MHC class II antigens are more critical than MHC class I antigen compatibility in determining graft survival. Matching of the ABO blood group system is also essential since A and B antigens can express endothelium. When there is a genetic disparity between donor and receptor, MHC class I and II can be seen as foreign by the immune system.
Option A: The client would most likely have acute hypertension. After a few days or weeks of successful transplantation surgery, the patient complains about tenderness at the site of the graft, pyrexia, and abnormal function of the organ or tissue graft, for example, in renal transplantation appears anuria, an increasing serum creatinine levels, and metabolic problems including hyperkalemia.
Option B: Acute rejection can associate with a high incidence of infections and other complications as the lethal graft-versus-host disease. It can recognize a single episode of acute rejection and promptly treat it, often preventing organ or tissue failure, but the recurrence can lead to chronic rejection.
Option C: The nurse would see elevated WBC counts and fever because the body is recognizing the graft as foreign and is attempting to fight it. Acute rejection relates well with class I and class II HLA gene disparity between donor and receptor. ABO matching protects against hyperacute transplantation rejection, which cannot be prevented with the use of immunosuppressive drugs.
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