title: Hyperacute rejection of a pulmonary allograft. Immediate clinical and pathologic findings.
abstract: The clinical and pathologic findings seen in hyperacute rejection are well documented in renal and cardiac allografts. We describe the second case of hyperacute rejection in a pulmonary allograft and detail the immediate clinicopathologic findings. The patient underwent a single lung transplant for severe COPD with postoperative course complicated by acute rejection and graft failure. Eleven days later, the patient underwent a second transplant with intra-operative course complicated by rapid pulmonary edema and copious production of frothy, pink fluid from the bronchial orifice of the allograft followed by death within four hours of anastomoses. Intraoperative biopsy and autopsy demonstrated platelet/fibrin thrombi, marked interstitial neutrophilia, alveolar edema, and antibody deposition on the endothelial surface and vasculature walls. Prior to the first transplant, the patient's serum had 0% panel reactive antibody and was crossmatch compatible with the first allograft. The patient's serum prior to the second transplant contained cross-reacting antibodies to the donor's B and T lymphocytes. The immediate clinical findings in this case are similar to the findings in a previously reported case. This report is the first documentation of the immediate pathologic features of hyperacute rejection in a lung allograft which are similar to those seen with other organ allografts.
authors.affiliation: Department of Pathology Hospital of the University of Pennsylvania, Philadelphia, USA.
authors.forename: J K
authors.initials: JK
authors.lastname: Choi
authors.forename: J
authors.initials: J
authors.lastname: Kearns
authors.forename: H I
authors.initials: HI
authors.lastname: Palevsky
authors.forename: K T
authors.initials: KT
authors.lastname: Montone
authors.forename: L R
authors.initials: LR
authors.lastname: Kaiser
authors.forename: C M
authors.initials: CM
authors.lastname: Zmijewski
authors.forename: J E
authors.initials: JE
authors.lastname: Tomaszewski
mesh_terms: D017809:Fatal Outcome; D005260:Female; D005434:Flow Cytometry; D006084:Graft Rejection / Q000276:immunology / Q000473:pathology*; D006650:Histocompatibility Testing; D006801:Humans; D007074:Immunoglobulin G / Q000276:immunology; D007431:Intraoperative Complications; D008168:Lung / Q000473:pathology; D008173:Lung Diseases, Obstructive / Q000601:surgery; D016040:Lung Transplantation / Q000276:immunology* / Q000473:pathology; D008875:Middle Aged; D011183:Postoperative Complications; D012086:Reoperation
chemical_list: D007074:Immunoglobulin G