hyperacute rejection of a transplanted kidney

Discussion in 'MRCS Forum' started by Lona., Jan 11, 2008.

  1. Lona.

    Lona. Guest

    Which of the following statements regarding hyperacute rejection of a transplanted kidney is true?
    a- It is mediated by performed donor antibodies against recipient HLA antigens
    b- It can be prevented by performing lymphocytotoxicity cross-match testing
    c- It is manifested grossly by a swollen, pale kidney at the time of transplant surgery
    d- This form of rejection is associated with disseminated intravascular coagulation (DIC)
    e- The rejection process can be treated with a steroid bolus and OKT3
  2. Lona.

    Lona. Guest

    Answer: c. (Greenfield, 2/e, pp 578-581) Hyper-acute rejection is mediated by cytotoxic antibodies with subsequent triggering of the complement, coagulation and kinin systems. It can occur during surgery after the clamps are released from the vascular anastomosis and the recipient’s antibodies are exposed to the donor’s passenger lymphocytes and kidney tissue. Typically, the kidney will become swollen and pale. Hyperacute rejection is the cause of immediate and early oliguria, and biopsies should be performed intraoperatively or early postoperatively. Hyperacute rejection is characterized pathologically by fibrin and platelet thrombosis and necrosis of the glomerular tufts, renal arterioles, and small arteries. Massive polymorphonuclear infiltrate with tubular necrosis occurs 24 to 36 h after transplantation. The intravascular coagulation rarely results in a systemic coagulopathy. Careful cross-matching can test for cytotoxic antibodies. Although plasmapheresis and Cyclophosphamide can transiently decrease he preformed antibody lead, to date there exists no adequate prevention or treatment for hyperacute rejection.

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