Acute cellular rejection, also called acute T-cell–mediated rejection (TCMR), presents in the transplant recipient with acute kidney injury and decreased urine output, and may be accompanied by proteinuria. In more severe cases there can be transplant tenderness. TCMR can develop at any time, as early as a week or as late as years after transplantation. With current immunosuppressive therapy, acute rejection develops in about 10%-12% of transplant patients. Pure TCMR responds well to increased immunosuppressive therapy.