Rejection after renal transplant within minutes and hours?

PGIMER NO - 2020

Medical & Surgical Nursing

Easy

Appeared in: PGIMER NO - 2020

Explanation

Hyperacute rejection is defined by its extremely rapid onset, occurring within minutes to hours after the new organ's blood vessels are connected.
It is a Type II hypersensitivity reaction caused by pre-existing antibodies in the recipient's blood that recognize the donor organ as foreign.
These antibodies trigger a massive inflammatory response, leading to thrombosis in the graft's blood vessels, ischemia, and irreversible necrosis.
Clinically, the graft becomes cyanotic and stops functioning almost immediately, necessitating its surgical removal.

Option A: Chronic rejection is incorrect because its onset is very slow, developing over months to years after the transplant.
Option B: Acute rejection is incorrect as it typically occurs later, from a few days to a few months post-transplant.
Option D: Subacute rejection is not a standard or recognized clinical classification for transplant rejection. The main types are hyperacute, acute, and chronic.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Classification and timing of renal transplant rejection as background academic context rather than a clinical decision trigger.
Nurses must perform vigilant post-operative monitoring of urine output, vital signs, and the surgical site. A sudden drop in urine output to zero in the immediate post-op period is a critical sign of hyperacute rejection requiring immediate surgeon notification.
Patient education is paramount. The nurse must teach the patient about the critical importance of lifelong immunosuppressive therapy to prevent acute and chronic rejection.
What if? If a patient develops fever, graft tenderness, and rising creatinine levels ten days post-transplant, the nurse should suspect acute rejection. This requires immediate notification of the transplant team for intervention with increased immunosuppression, as it is often reversible, unlike hyperacute rejection.

How to Approach the Question

First, identify the keywords in the question stem: 'renal transplant rejection' and the specific timeframe 'within minutes and hours'.
Recall the three main classifications of transplant rejection, which are primarily defined by their timing.
Associate 'hyperacute' with an immediate reaction (minutes to hours).
Associate 'acute' with a short-term reaction (days to weeks/months).
Associate 'chronic' with a long-term deterioration (months to years).
Match the timeframe given in the question ('minutes and hours') to the corresponding type of rejection, which is hyperacute.

Concept Tested & Keywords

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