Review Question - QID 100498

Based on the time-frame, the patient has experienced hyperacute rejection of the kidney. In hyperacute rejection, pre-formed antibodies rapidly bind to the vasculature of the grafted tissue and result in thrombosis. Graft mottling, cyanosis, bloody urine (if the graft is already connected to the bladder), and histological evidence of vascular damage are seen. Histological evidence of arteriosclerosis is characteristic of chronic rejection as opposed to hyperacute rejection, and thus would not be described by this physician to his residents.

Hyperacute graft rejection is an example of a type II hypersensitivity reaction in which immunoglobulins bind antigens on the surface of cells. This binding can mediate the recruitment of leukocytes as well as the activation of complement. This, in turn, leads to cellular damage. Other examples of type II hypersensitivity include hemolytic anemia, myasthenia gravis, and Goodpasture's syndrome.

Al-rabia stresses the role of complement in hyperacute rejection and states that identification of complement split products (such as C4d) in biopsies of failed transplants can be used as an important tool in diagnosing antibody mediated rejections.

Taylor describes CMV infection as another problem in transplant patients. Acquiring CMV from the donor can result in CMV syndrome (fever, leukopenia, atypical lymphocytes, hepatomegaly, myalgia, and arthralgia) and is the most common manifestation of primary CMV in kidney transplant patients.

Illustration A summarizes the mechanisms of the three main types of transplant rejection: hyperacute, acute, and chronic.

Incorrect Answers:
Answer 1,2,3,5: These answer choices are all characteristic of hyperacute rejection and would most likely be described by the physician to his residents.