Hyperacute rejection

Hyperacute rejection

Hyperacute rejection is extremely rare. It can result from an inadvertent ABO blood group-incompatible transplantation after a clerical error in recording blood groups. It may also occur when there are preformed circulating donor-specific HLA antibodies (DSA) or ABO antibodies. In either case, - immediately after revascularisation of the transplant anti - bodies will bind to ABO or HLA antigens on the surface of the graft vascular endothelial cells. The antibodies are comple - ment fixing and this leads to activation of the complement cascade and phagocytes. This leads to endothelial damage with release of tissue factor and activ ation of the clotting cascade . - Widespread intravascular thrombosis causes infarction of the allograft within minutes or hours. This is untreatable and inevitably results in graft loss.