Nephrology & Renal Medicine

Acute T-Cell Mediated Allograft Rejection (Banff Grade)

ICD-10 Code

T86.11

Allograft rejection driven by host T-cell infiltration into the transplanted kidney. Classified by the Banff criteria based on the severity of tubulitis (t-score) and interstitial inflammation (i-score) for Grade IA/IB, or intimal arteritis (v-score) for Grade IIA/IIB.

Clinical Presentation & Protocol

Patient Usually Complains Of

Patient presents with [acute/subacute] rise in serum creatinine of [X] mg/dL from baseline. Associated symptoms include decreased urine output, graft tenderness, low-grade fever, and fluid retention. No history of recent medication non-adherence or systemic infection. Biopsy-proven Acute T-Cell Mediated Rejection (Banff Grade [IA/IB/IIA/IIB]).

Clinical Examination Findings

General appearance: Alert and oriented. Vital signs: [BP/HR/Temp]. Graft site: Palpable, tender to deep palpation, no overlying erythema or fluctuance. Extremities: [1+/2+] pitting edema noted in lower extremities.

Treatment Protocol

Initiate pulse corticosteroid therapy (Methylprednisolone [X] mg IV daily for 3 days). If Banff Grade IIA/IIB or steroid-resistant, consider Thymoglobulin (ATG) induction. Monitor for opportunistic infections, adjust maintenance immunosuppression, and repeat serum creatinine/graft function labs in 24-48 hours.

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