After a renal transplant, which sign most suggests rejection?

• A. Oliguria with rising creatinine and graft tenderness.
• B. Hypertension without graft tenderness.
• C. Fever and weight gain only.
• D. Normal renal function.

Answer: (A)

Acute graft rejection most strongly shows up as a decrease in kidney function after transplantation, evidenced by oliguria with a rising serum creatinine, often accompanied by tenderness over the graft from inflammation. This combination directly reflects immune-mediated injury to the transplanted kidney, impairing its filtration capacity and producing local swelling that causes tenderness. Other signs like hypertension or fever with weight gain can occur but are nonspecific, and normal renal function essentially argues against rejection. If suspicion arises, prompt evaluation (often including a biopsy) and adjustment of immunosuppressive therapy are essential to protect the graft.