Am. J. Respir. Crit. Care Med.,
Volume 160, Number 3, September 1999, 1015-1018
Hyperacute Rejection of a Pulmonary Allograft
Immediate Clinical and Pathologic Findings
JOHN K.
CHOI,
JANE
KEARNS,
HAROLD I.
PALEVSKY,
KATHLEEN T.
MONTONE,
LARRY R.
KAISER,
CHESTER M.
ZMIJEWSKI,
and
JOHN E.
TOMASZEWSKI
Departments of Pathology and Laboratory Medicine, Medicine, and Surgery, Hospital of the University of Pennsylvania,
Philadelphia, Pennsylvania
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.
