Kidney non-tumor - Hyperacute rejection

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Kidney non-tumor

Kidney transplantation

Hyperacute rejection

Reviewers: Nikhil Sangle, M.D. (see Reviewers page)
Revised: 26 December 2012, last major update August 2012
Copyright: (c) 2003-2012, PathologyOutlines.com, Inc.

General
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● 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
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● With negative pretransplantation T- and B-cell flow cytometric crossmatches and blood group identity (Transplant Proc 2008;40:2422)

Gross description
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● Mottled cyanosis and diminished turgor in renal graft

Gross images
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Cortex is blue, edematous and congested.

Micro description
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● 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

Micro images
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Various images

Immunofluorescence
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● 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
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● Capillary occlusion by degranulated platelets and endothelial denudation of glomerular basement membrane
● Also fibrin, sludged red blood cells

Differential diagnosis
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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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