A 44-year-old man with diabetic nephropathy undergoes a renal transplant. One week later, he develops low-grade fever, body aches, and decreased urine output. Temperature is 37.2 C (99 F), blood pressure is 124/76 mm Hg, and pulse is 88/min. Physical examination shows mild tenderness over the graft on palpation. Serum creatinine is 2.2 mg/dL, an increase from 1.2 mg/dL two days ago. Arterial and venous Doppler studies reveal adequate graft perfusion. Graft biopsy demonstrates dense interstitial infiltration by mononuclear cells. Which of the following is the most likely cause of this patient's current condition?

Question

A 44-year-old man with diabetic nephropathy undergoes a renal transplant.  One week later, he develops low-grade fever, body aches, and decreased urine output.  Temperature is 37.2 C (99 F), blood pressure is 124/76 mm Hg, and pulse is 88/min.  Physical examination shows mild tenderness over the graft on palpation.  Serum creatinine is 2.2 mg/dL, an increase from 1.2 mg/dL two days ago.  Arterial and venous Doppler studies reveal adequate graft perfusion.  Graft biopsy demonstrates dense interstitial infiltration by mononuclear cells.  Which of the following is the most likely cause of this patient's current condition?

Quizplus · Accepted Answer

Eductional Objective: Organ rejection can be hyperacute, acute, or chronic.  Acute rejection most often occurs within weeks or up to 6 months after transplant and is predominantly cell-mediated, involving sensitization of host T lymphocytes against donor MHC antigens.  There is typically graft dysfunction with histology showing a dense, mononuclear (ie, lymphocytic) infiltrate.

A 44-Year-Old Man with Diabetic Nephropathy Undergoes a Renal Transplant