Transplant Rejection, Teaching, and Long-Term Monitoring

Definition and mechanism.Rejection is injury to a transplanted organ caused by the recipient's own immune system, which recognizes donor tissue antigens (mainly human leukocyte antigens, HLA) as foreign. Two arms of immunity can attack a kidney allograft. In T-cell-mediated (cellular) rejection, recipient T lymphocytes infiltrate the graft interstitium, tubules and sometimes vessels. In antibody-mediated rejection, circulating recipient antibodies bind donor antigens on the endothelial cells lining graft blood vessels; these are called donor-specific antibodies (DSA). Maintenance immunosuppression exists to keep both arms quiet for the life of the graft, which is why recipients take anti-rejection medicine every day, permanently. Why it matters for nursing in Canada. According to the Canadian Organ Replacement Register, 3,369 solid organ transplants were performed in Canada in 2023, and 19,356 Canadians were living with a functioning kidney transplant (Quebec excluded from these counts). Of the 3,427 people waiting for a solid organ at the end of 2023, 71% were waiting for a kidney. Nurses in emergency, medical, surgical, community and primary care settings therefore regularly care for kidney recipients outside the transplant centre. Patterns...