title: Hyperacute rejection of a living unrelated kidney graft.
abstract: We present a case report of a 59-year-old man, who received a blood group identical living unrelated kidney graft. This was his second kidney transplantation. Pretransplant T-cell crossmatch resulted negative. B-cell crossmatch, which is not considered a strict contraindication for transplantation, resulted positive. During surgery no abnormalities occurred. Four hours after the transplantation diuresis suddenly decreased. In an immediately performed relaparotomy the transplanted kidney showed signs of hyperacute rejection and had to be removed. Pathological examination was consistent with hyperacute rejection. Depositions of IgM or IgG antibodies were not present in pathologic evaluation of the rejected kidney, suggesting that no irregular endothelial specific antibodies had been involved in the rejection. We recommend examining more closely recipients of second allografts, considering not only a positive T-cell crossmatch but also a positive B-cell crossmatch as exclusion criteria for transplantation.
authors.affiliation: Department of General and Visceral Surgery, University of Freiburg, Hugstetter Straße 55, 79106 Freiburg im Breisgau, Germany ; Department of General Surgery, University Hospital Lübeck, University of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany.
authors.forename: Dietlind
authors.initials: D
authors.lastname: Tittelbach-Helmrich
authors.affiliation: Department of General and Visceral Surgery, University of Freiburg, Hugstetter Straße 55, 79106 Freiburg im Breisgau, Germany ; Department of General Surgery, University Hospital Lübeck, University of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany.
authors.forename: Dirk
authors.identifier: 0000-0001-6511-1535
authors.initials: D
authors.lastname: Bausch
authors.affiliation: Department of General and Visceral Surgery, University of Freiburg, Hugstetter Straße 55, 79106 Freiburg im Breisgau, Germany.
authors.forename: Oliver
authors.initials: O
authors.lastname: Drognitz
authors.affiliation: Institute of Pathology, University of Freiburg, Breisacher Straße 115a, 79106 Freiburg im Breisgau, Germany.
authors.forename: Heike
authors.identifier: 0000-0002-0171-7025
authors.initials: H
authors.lastname: Goebel
authors.affiliation: Department of Transfusion Medicine, University of Freiburg, Hugstetter Straße 55, 79106 Freiburg im Breisgau, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Schulz-Huotari
authors.affiliation: Department of Nephrology, University of Freiburg, Hugstetter Straße 55, 79106 Freiburg im Breisgau, Germany.
authors.forename: Albrecht
authors.identifier: 0000-0002-4701-398X
authors.initials: A
authors.lastname: Kramer-Zucker
authors.affiliation: Department of General and Visceral Surgery, University of Freiburg, Hugstetter Straße 55, 79106 Freiburg im Breisgau, Germany.
authors.forename: Ulrich Theodor
authors.initials: UT
authors.lastname: Hopt
authors.affiliation: Department of General and Visceral Surgery, University of Freiburg, Hugstetter Straße 55, 79106 Freiburg im Breisgau, Germany.
authors.forename: Przemyslaw
authors.initials: P
authors.lastname: Pisarski