Kidney nontumor
Diseases of renal allograft
Hyperacute rejection

Author: Nikhil Sangle, M.D.(see Authors page)

Revised: 6 February 2018, last major update December 2012

Copyright: (c) 2002-2017, PathologyOutlines.com, Inc.

PubMed Search: Hyperacute rejection [title]

Cite this page: Sangle, N. Hyperacute rejection. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/kidneyhyperacuterejection.html. Accessed February 19th, 2018.
Definition / general
  • 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
Case reports
Gross description
  • Mottled cyanosis and diminished turgor in renal graft
Gross images

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Cortex is blue, edematous and congested

Microscopic (histologic) description
  • 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
Microscopic (histologic) images

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Various images

Immunofluorescence
  • 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
Differential diagnosis
    Other conditions that can cause primary graft failure include:
  • Acute tubular necrosis
  • Major vascular occlusion
  • Perfusion injury