Reviewers: Nikhil Sangle, M.D. (see Reviewers page)
Revised: 26 December 2012, last major update August 2012
Copyright: (c) 2003-2012, PathologyOutlines.com, Inc.
● Occurs within minutes to hours after revascularization, causing abrupt cessation of urine production
● Due to preformed circulating antibodies in recipient to donor endothelial cells, caused by prior pregnancies, blood transfusions or transplants
● Can perform ABO-incompatible transplants if low titers (Nephrol Dial Transplant 2010;25:3794)
● Rare currently due to routine screening and cross matches
● With negative pretransplantation T- and B-cell flow cytometric crossmatches and blood group identity (Transplant Proc 2008;40:2422)
● Mottled cyanosis and diminished turgor in renal graft
Cortex is blue, edematous and congested.
● Fibrin thrombi in glomerular capillaries, peritubular venules and other vessels leading to infarction and tubular necrosis
● Variable white blood cells within glomeruli, peritubular capillaries and interstitium
● Linear staining of IgM or IgG, as well as C3 and C4d along glomerular and peritubular capillaries
● At later stages Ig may not be detectable
Electron microscopy description
● Capillary occlusion by degranulated platelets and endothelial denudation of glomerular basement membrane
● Also fibrin, sludged red blood cells
Other conditions that can cause primary graft failure include:
● Acute tubular necrosis
● Perfusion injury
● Major vascular occlusion
End of Kidney non-tumor > Kidney transplantation > Hyperacute rejection
Ref Updated: 8/30/12
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