Hyperacute rejection of the kidney in patients with a negative crossmatch.

Abstract

Hyperacute rejection (HAR) of the kidney was first recognized 20 years ago in cases of donor-recipient incompatibility for the major blood group and tissue antigen systems.1–3 Recently, three patients at the University of Pittsburgh developed immediate graft dysfunction after receiving a kidney from an ABO-compatible cadaveric donor with a negative warm lymphocytotoxic cross-match. None of the patients had prior transplants or transfusion therapy, and the ischemia times were comparable. One patients had a high panel reactive antibody (PRA) (100% remote, 76% at transplant). The immunopathologic and histopathologic features of these cases were compared with those of a control group without HAR. Our findings suggest that the cascade involved in HAR may be triggered by mechanisms other than those classically described.