Hyperacute rejection in human-kidney allografts -- Shwartzman or Arthus reaction?

Abstract

Abstract The course of three patients indicated that both types of reaction, Shwartzman and Arthus-like, can occur in hyperacute rejection of human-kidney allografts and that the late histologic appearances may be indistinguishable. In the first patient hyperacute failure of the kidney occurred in four hours, in association with the development of a bleeding diathesis. Sequential histologic appearances were those of progressive fibrin deposition resembling a generalized Shwartzman reaction. In the second patient, two consecutive kidneys from the same donor were rejected within minutes of revascularization despite prophylactic heparinization. There was neutrophil infiltration without fibrin deposition. At four days there was cortical necrosis, fibrin thrombi in glomerular capillaries and minimal cellular infiltration. A third patient, without prophylactic heparin, showed both neutrophil infiltration and fibrin deposition at one hour and cortical necrosis at five days.