Abstract A series of 125 renal transplants were analyzed in order to ascertain the characteristics of accelerated allograft rejection. An intense accelerated rejection could be identified within the first five days in 12 of 67 transplants (18%) with good immediate renal function. Accelerated rejection differed from the usual acute rejection reaction by higher fever, increased duration and intensity of the rejection, and increased difficulty in reversing the reaction. Accelerated rejection was reversible and associated with satisfactory renal function one year posttransplant in 58% of patients. Lymphocytotoxic and heterophile antibodies in preoperative serum and eluates of removed kidneys were not present. Contrary to recent reports, accelerated renal allograft rejection is a potentially reversible process and not necessarily due to humoral antibody presensitization. References 1. Kountz SL: Clinical transplantation: An overview . Transplant Proc 5:59-65, 1973. 2. Lucas ZJ, Coplon N, Kempson R, et al: Early renal transplant failure associated with subliminal sensitization . Transplantation 10:522-529, 1970.Crossref 3. McDonald JC: A heterophile system in human renal transplantation: II. Relationship to clinical renal transplantation and the HL-A system . Transplantation 15:123-128, 1973.Crossref 4. Moore TC, Berne TV, English TS: Accelerated rejection of 36 immediate posttransplant functioning machine-preserved human cadaveric kidneys . Surgery 75:357-367, 1974. 5. Moore TC, English TS, Berne TV: Machine preservation of 302 human cadaveric kidneys for transplantation . Surg Gynecol Obstet 138:239-243, 1974. 6. Pillay VKG, Kurtzman NA, Manaligod JR, et al: Selective thrombocytopenia due to localized microangiopathy of renal allografts . Lancet 2:988-991, 1973.Crossref 7. Mittal KK, Mickey MR, Singal DP, et al: Serotyping for homotransplantation: XVIII. Refinement of microdroplet lymphocyte cytotoxicity test . Transplantation 6:913-927, 1968.Crossref 8. Colberg JE, McGrath P, Cress H, et al: The crossmatch profile and other extended crossmatch methods in clinical transplantation . Ann Surg 105:237-241, 1972. 9. McDonald JC: A heterophile system in human renal transplantation: I. Distribution of antigens and reactivity of the antibodies . Transplantation 15:116-122, 1973.Crossref 10. Lerner RA, Glassock RJ, Dixon FJ: The role of anti-glomerular basement membrane antibody in the pathogenesis of human glomerulonephritis . J Exp Med 126:989-1004, 1967.Crossref 11. McDonald JC, Mukherjee GN: A heterophile system in human renal transplantation: III. The HT-A specificities . Transplant Proc 5:481-485, 1973. 12. Anderson CB, Graff RJ, Newton WT: Serum lactic dehydrogenase and human renal allograft failure , in Abstract Book of the Fifth International Congress of the Transplantation Society , Jerusalem, Transplantation Society, 1974. 13. Filo RS, Dickson LG, Suba EA, et al: Immunologic injury induced by ex vivo perfusion of canine renal allografts . Surgery 78:88-100, 1974. 14. Cross DE, Whittier FC, Cuppage FE, et al: Hyperacute rejection of renal allografts following pulsatile perfusion with a perfusate containing specific antibody . Transplantation 17:626-629, 1974.Crossref 15. Rapaport FT, Dausset J, Hamburger J, et al: Serologic factors in human transplantation . Ann Surg 166:596-608, 1967.Crossref 16. Rapaport FT, Kano K, Milgrom F: Heterophile antibodies in human transplantation . J Clin Invest 47:633-642, 1968.Crossref 17. Merrill JP: Diagnosis and management of rejection in allografted kidneys . Transplant Proc 3:287-292, 1971.
Archives of Surgery – American Medical Association
Published: Oct 1, 1975