Review Question - QID 106676

This patient is suffering from hyperacute rejection of the transplanted organ, occurring within minutes after the transplantation. Hyperacute rejection is a type II hypersensitivity reaction caused by preformed antidonor antibodies in the transplant recipient.

There are three types of transplant rejection: hyperacute, acute, or chronic. Hyperacute rejection occurs when preformed antidonor antibodies result in complement activation, leading to endothelial damage, inflammation, and thrombosis. Acute rejection occurs weeks after the transplantation and is a cell-mediated reaction due to cytotoxic T lymphocytes reacting against foreign MHCs. Chronic rejection, occurring months to years after the initial transplantation, is due to T-cell and antibody mediated vascular damage leading to obliterative vascular fibrosis.

Rosansky discusses the potential treatment options for end-stage renal disease, including hemodialysis, peritoneal dialysis, or transplantation. Home dialysis and related donor kidney transplantation offer the best chance for patient survival and full rehabilitation.

Levine et al. discuss management options for antibody-mediated rejection after kidney transplantation. Antibody-mediated rejection, manifesting as a wide range of clinical presentations from hyperacute rejection to a more indolent chronic rejection course, is generally associated with decreased graft survival. For hyperacute rejection, the treatment is typically to remove the donor organ; however, for less immediate and severe rejection, treatments options can include antithymocyte globulin, intravenous immune globulin, plasmapheresis, rituximab, bortezomib, or eculizumab.

Illustration A summarizes the mechanisms for the three types of transplant rejection: hyperacute, acute, and chronic. Illustration B shows occlusion of an artery by a fibrin thrombus in a patient who suffered from hyperacute rejection.

Incorrect Answers:
Answers 1,3-5: Hyperacute rejection is a type II hypersensitivity reaction.