By Jack Fassnacht, two time kidney transplant recipient
Transplant recipients I have spoken with tell me that experiencing acute kidney transplant rejection, the kind of rejection that happens quickly, sometimes mere days or weeks after a transplant, can bring up lots of complex feelings, including failure, disappointment, guilt and even depression. Having had a living donor transplant may intensify these feelings for some.
The problem, according to my nephrologist, Dr. Brian Duffy, can be that many kidney patients view transplantation as a way to "escape" dialysis. When acute rejection occurs, these patients feel like their "way out" of dialysis failed them. They believe their life will inevitably be less happy and less fulfilling on dialysis, when that is not necessarily the case. The media reinforces the notion that dialysis is a poor alternative when they depict transplantation as a miraculous "cure."
"It's important to view transplantation as just one alternative and effective method for treating kidney failure," explains Dr. Duffy. "The other method is dialysis—which also can be effective in helping persons with kidney failure lead happy and productive lives." Transplantation, then, should be viewed not as an escape from dialysis, but as another method of treating kidney disease. Indeed, for various reasons, some people either prefer dialysis or, due to age and health factors, are not candidates for transplantation. For these people dialysis is the best option.
It is also important to know that the transplant operation is not without risk, and that transplantation does not always work. If you know that going in, then rejection may not be quite as devastating, should it occur.
To those who have experienced acute rejection, Dr. Duffy has this advice: "Don't lose sight of the fact that you still have good treatment options in addition to transplantation, and you can still live, and live well, on dialysis." Dr. Duffy encourages those whose transplants didn't take, to continue to eat well and stay involved in life.
He also urges patients who have experienced rejection, whether acute or chronic, to consider having another transplant. Acute rejection doesn't exclude a person from being re-transplanted. If you have experienced rejection, it may be time to pick yourself up, dust yourself off, and try again.
As someone who suffered from the slow, chronic rejection of my first transplant, I had a lot of time to consider what I would do when my transplanted kidney could no longer keep me healthy. I had some perspective with which to make a decision, having been on both peritoneal dialysis and hemodialysis. Yet the more I thought about it, the more I realized I didn't have a strong preference. As the time approached to make a decision about my "post transplant" care, my youngest sister Paula stepped forward and became my second donor.
The important point is that a person can live well both on dialysis and with a transplant. I myself have experienced happy and fulfilling times—as well as some of life's travails— while on dialysis and after being transplanted.
Not surprisingly, different people have different reactions to acute rejection. How each person reacts has a great deal to do with that person's coping mechanisms. One's outlook on life can be extremely important, and some people just manage to have more positive outlooks than others.
In those cases where depression takes hold of a person after acute rejection and doesn't let go, it can help to talk with your support group: friends, relatives and your health care professionals. Remember: you are not alone. Not all transplants work, but fortunately there is dialysis and often re-transplantation to help each of us dealing with kidney disease live a happy and fulfilling life.