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The success of a kidney transplant largely depends on patient awareness, consistent care, and adherence to medical advice
World Kidney Day 2025: For promoting kidney health, nutritionists and fitness coaches are constantly advocating for the 8 golden rules for kidney health. (Image: Shutterstock)
A kidney transplant offers a renewed chance at life for patients with kidney failure, often serving as a turning point in their health journey. However, transplant failure remains a potential risk, making it crucial to understand its causes and preventive measures. From a nephrologist’s perspective, identifying these factors can improve long-term graft outcomes and survival. Dr. L. K. Jha, Director and Senior Consultant – Nephrology and Kidney Transplant, Dharamshila Narayana Superspeciality Hospital, Delhi helps us identify
Causes of Kidney Transplant Failure
1. Immune Rejection The patient’s immune system may recognize the new kidney as a “foreign body” and attempt to reject it. Rejection can occur in three forms:
○ Hyperacute Rejection: Happens immediately after the transplant (within minutes) but is rare due to improved screening protocols.
○ Acute Rejection: Occurs within weeks to months post-transplant.
○ Chronic Rejection: Progresses slowly over several years, gradually damaging the transplanted kidney.
Rejection may result from preformed or newly developed antibodies, or immune cells like lymphocytes that damage kidney nephrons. The most common reason for rejection is patients skipping or stopping their immunosuppressive medications.
2. Infections: Immunosuppressive drugs weaken the immune system, making patients vulnerable to infections. Severe infections can damage the transplanted kidney or lead to failure. Post-transplant infections can be viral (e.g., CMV), fungal, bacterial, or tubercular. These infections often target the urinary tract, lungs, or gastrointestinal system and may spread through the bloodstream, sometimes becoming life-threatening.
3. Uncontrolled Blood Pressure and Diabetes Poorly controlled blood pressure or blood sugar can strain the new kidney, increasing the risk of damage. Additionally, immunosuppressive medications increase the likelihood of developing hypertension, diabetes, and metabolic syndrome.
4. Recurrent Disease Certain conditions that caused the original kidney failure may return in the transplanted kidney. Diseases such as FSGS (Focal Segmental Glomerulosclerosis), IgA nephropathy, and Membranoproliferative Glomerulonephritis can recur, potentially damaging the new organ.
5. Lifestyle Factors and Poor Follow-Up An unhealthy lifestyle, smoking, excessive alcohol consumption, lack of exercise, or missing regular follow-ups can shorten the transplanted kidney’s lifespan. Mental well-being and stress management also play a crucial role in recovery.
6. Post-Transplant Malignancy or Lymphoproliferative Disorder In rare cases, these conditions can develop and significantly affect the transplanted kidney’s function.
7. Surgical Complications Issues during the transplant procedure, such as excessive bleeding, thrombosis, surgical trauma, prolonged ischemia time, severe hypotension, or cytokine release syndrome, can jeopardize the kidney’s function and lead to graft failure.
How to Prevent Transplant Failure
● Take medications on time and exactly as prescribed by your nephrologist.
● Get regular blood tests and health check-ups to monitor kidney function.
● Maintain a balanced diet and engage in light physical activity.
● Ensure proper hygiene and follow infection prevention guidelines.
● Contact your doctor immediately if you notice any signs of infection or kidney disease.
● Follow vaccination recommendations for transplant recipients to reduce infection risks.
The success of a kidney transplant largely depends on patient awareness, consistent care, and adherence to medical advice. By understanding potential causes of transplant failure and taking proactive measures, patients can protect their new kidney and enjoy a healthier, more productive life. If you or someone you know has undergone a kidney transplant, consulting an experienced nephrologist for ongoing guidance and care can ensure long-term success and improved quality of life.
