Abstract
SUMMARY Hyperacute rejection of cardiac allografts was studied in dogs sensitized by two previous heart, kidney, or skin grafts or more. Organ donors were selected on the basis of a positive cytotoxicity test using the donor's lymphocytes and the recipient's serum. Eight of the 19 heart grafts were rejected in less than 4 hr; 7 of the 8 were rejected in less than 1 hr. Characteristic gross changes included cyanosis and turgor. Serial biopsies of myocardium within the first 1/2 hr showed interstitial edema and hemorrhage, but no infiltration with inflammatory cells. Small arterioles and capillaries were occluded by clumps of platelets. In most hearts, immunofluorescence staining revealed IgG in the walls of blood vessels and on the sarcolemma. Bound complement (β10-globulin) was seldom detected. There was some correlation between the occurrence of hyperacute rejection and the titer of cytotoxic antibody in the recipient's serum against the donor's lymphocytes. It is suggested that antibody-antigen complexes formed in the graft cause platelet aggregation with occlusion of the lumen and damage to the walls of small blood vessels.
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