Which symptom most strongly suggests acute rejection in a renal transplant recipient?

• A. New allograft pain
• B. Intermittent headaches
• C. Mild dehydration
• D. Skin rash at site

Answer: (D)

Acute rejection typically presents with inflammation centered on the transplanted kidney, and the most specific clue is new graft tenderness or pain over the transplant site. This pain reflects immune attack on the graft and is often accompanied by a rise in creatinine and reduced urine output, though the pain itself is a strong and early signal.

Intermittent headaches are nonspecific and not tied to the graft itself. Mild dehydration can occur for many reasons and does not point to rejection. A skin rash at the site is more suggestive of infection, a local reaction, or a drug-related issue rather than rejection of the kidney.

So, new graft pain stands out as the symptom most strongly associated with acute rejection.