Signs of rejection and infection to report after a kidney transplant

One of the commonest worries after a transplant is not knowing which aches, temperatures or tired days are ordinary and which deserve a phone call. This page gathers what public health bodies list as signs of rejection (the immune system attacking the new kidney) and infection, who they say to contact, and why reporting early is stressed so strongly. These are general descriptions and not a way to judge your own symptoms. Practice differs between transplant centres, so your own transplant team has the final word, including who to ring and when.

Why prompt reporting matters

The main reason is that these problems can be quiet. The American Society of Transplantation says there are no specific symptoms of rejection and that typically you will not feel anything. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) in the United States says rejection often begins before you feel any change, and that routine blood tests at the transplant centre can reveal the early signs.

Infection adds another layer. The NIDDK warns that anti-rejection medicines raise the risk of infection and can dull the symptoms of problems such as infection, so a mild-looking illness may be less mild than it feels. The National Kidney Federation, a UK charity, puts the advice this way: in the weeks, months and years after a transplant, if you do not feel well, have a low threshold for contacting your local transplant team.

Early contact matters because early treatment is more manageable. The NIDDK says your provider will treat early signs of rejection by adjusting your medicines. NHS Blood and Transplant says many transplant patients experience rejection, that it is usually mild, and that it can be treated with different medications. Because blood tests at clinic are often where problems first show, it also says to attend all your scheduled appointments, a point we expand on in clinic follow-up and what the tests mean.

When sources say to contact the transplant team

NHS Blood and Transplant lists the following as reasons to contact your transplant team:

• A high temperature of 38 degrees Celsius or above
• Feeling hot and shivery
• Severe headache
• Diarrhoea or vomiting
• Shortness of breath
• New chest pain
• Fatigue, or generally feeling "rough"
• Little or no urine

The National Kidney Federation, in guidance written by a consultant transplant surgeon, gives a similar list and adds pain over the transplant and passing less urine than normal. The NIDDK tells readers to call the transplant centre right away if they are not feeling well or have a fever, drainage from the surgical scar, burning when passing urine, or a cold or cough that will not go away. The NIDDK, a US body, puts its fever figure at more than 100 degrees, which is on the Fahrenheit scale, so you may see different numbers on UK and US pages.

Notice how ordinary some of these are. Tiredness, diarrhoea and a cough are common in anyone, which is exactly why transplant teams would rather hear about them early than late. Your centre will give you its own list and telephone numbers, including for evenings and weekends, and the early-weeks overview in the first months after a kidney transplant explains how follow-up fits around them.

Signs sources link to rejection

Because rejection can be silent, the lists are short and cautious. The American Society of Transplantation says chills, body aches, nausea, cough, fever, shortness of breath, swelling from fluid build-up, weight gain and an increased creatinine level have been associated with severe rejection. Creatinine is a waste product measured in blood tests, and a rise can lead the team to do more tests, including a kidney biopsy, in which a small sample of kidney tissue is examined under a microscope.

The NIDDK adds that you may develop high blood pressure or notice swelling because the kidney is not getting rid of extra salt and fluid. The National Kidney Federation names pain over the transplant. Many of these signs also fit other problems, including infection, so working out the cause is the team's job. The NIDDK says the body may still reject a donor kidney even if you do everything you should. How the medicines themselves are used is covered in immunosuppressant medicines and living with them.

Signs of infection and wound problems

NHS Blood and Transplant says infections are very common immediately after surgery and can occur months or years later, partly because immunosuppressant medicines weaken the immune system. Chest and urinary infections are the most common, they can be treated with antibiotics and antivirals, and serious infections are rare. The American Society of Transplantation lists fever of 100.4 degrees Fahrenheit or above, chills, diarrhoea, fatigue, loss of appetite, shortness of breath, cough, coughing up thick mucus, difficulty or discomfort with urinating, skin rash and unexplained pain.

The wound deserves a separate look. The same society advises checking your incision every day and contacting the transplant centre right away if you notice redness, swelling, more pain or leaking fluid, and it says not to bathe or swim until the incision has fully healed because this can introduce bacteria. The longer-term picture on infection, including skin checks, is in staying well long term after a transplant, and vaccine advice is in travel and vaccines after a transplant.

When emergency services come into it

For most of the symptoms above, the sources send you to your transplant team first. Some entries on the NHS Blood and Transplant list, such as shortness of breath and new chest pain, can be serious on any day of the year. The NHS says 999 is for life-threatening emergencies, giving strokes and heart attacks among its examples, and that NHS 111 can check your symptoms if you are not sure whether you need to call 999. The number differs outside the UK.

The sources we read do not set a symptom-by-symptom rule for when to choose 999 over a call to the team, so this is worth settling in advance. Ask your transplant team who to ring out of hours and what they would want you to do if symptoms came on suddenly. Writing the answers next to the phone numbers helps if you are unwell and someone else has to make the call.

The short version

Rejection and infection can both be quiet after a kidney transplant, so public bodies list a broad set of signs and advise contacting the transplant team early, including for a high temperature, little or no urine, shortness of breath, new chest pain or a worsening wound. Reporting early gives the team the best chance to adjust treatment, and attending every clinic visit catches problems you cannot feel. Your own team can tell you whom to ring and when to seek emergency help.