Renal transplant postoperative care includes monitoring for signs of rejection. Which symptom would be concerning for acute rejection in the early postoperative period?

• A. Decreased urine output, rising creatinine, fever
• B. Increased appetite and weight gain
• C. Improved urine output with stable labs
• D. Decreased thirst and dehydration

Answer: (A)

The main idea here is recognizing signs of graft dysfunction that point to acute rejection after a renal transplant. In the early postoperative period, the transplanted kidney should be working well, so a drop in urine output and a rising creatinine level indicate the kidney isn’t filtering normally. Fever can accompany rejection as the immune system reacts against the graft. When you see a combination of oliguria (decreased urine output), rising creatinine, and fever, it raises strong concern for acute rejection needing prompt evaluation and possible treatment.

The other options don’t fit this scenario. Increased appetite and weight gain aren’t typical indicators of rejection. Improved urine output with stable labs suggests the graft is functioning well rather than being rejected. Decreased thirst and dehydration don’t specifically reflect rejection and could be due to various unrelated factors.