Manifestations of Transplant Rejection by Category

Organ

Hyperacute

Accelerated

Acute

Chronic

Kidney

Fever, anuria

Fever, oliguria, graft swelling and tenderness

Fever, increased serum creatinine, hypertension, weight gain, graft swelling and tenderness

Appearance of protein, lymphocytes, and renal tubular cells in urine sediment

Proteinuria with or without hypertension, nephrotic syndrome

Liver

Fever, very elevated liver function test results (AST, bilirubin), coagulopathy

Fever, coagulopathy, very elevated liver function test results (AST, bilirubin), ascites

Anorexia, pain, fever, jaundice, light (clay)-colored stools, dark urine, elevated liver function test results (AST, bilirubin)

Jaundice, vanishing bile duct syndrome (with elevated bilirubin, alkaline phosphatase, and gamma-glutamyl transpeptidase), slightly elevated liver function test results (AST, bilirubin), ascites

Heart*

Cardiogenic shock

Atrial arrhythmia, cardiogenic shock

Heart failure, atrial arrhythmia

Dyspnea during exertion, low stress tolerance

Lung

Poor oxygenation, fever, cough, dyspnea, decreased FEV1

Poor oxygenation, fever, cough, dyspnea, infiltrate seen on chest x-ray, decreased FEV1

Same as those for accelerated

Interstitial perivascular infiltrate (detected by transbronchial biopsy)

Obliterative bronchiolitis, cough, dyspnea

Pancreas

Pancreatic necrosis, fever, hyperglycemia

Pancreatitis, hyperglycemia, elevated amylase and lipase

Same as those for accelerated

Hyperglycemia, mildly elevated amylase and lipase

Small bowel

Fever, very elevated lactic acid

Fever, diarrhea, elevated lactic acid

Fever, diarrhea, malabsorption, mildly elevated lactic acid

Diarrhea, malabsorption

* Most patients with heart transplant rejection are asymptomatic.

AST = aspartate aminotransferase; FEV1= forced expiratory volume in 1 second.