Hyperacute rejection of a pulmonary allograft - Immediate clinical and pathologic findings

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 clin icopathologic findings. The patient underwent a single lung transplant for severe COPD with postoperative course complicated by acute rejection and gr aft failure. Eleven days later, the patient underwent a second transplant w ith intra-operative course complicated by rapid pulmonary edema and copious production of frothy, pink fluid from the bronchial orifice of the allogra ft followed by death within four hours of anastomoses. Intraoperative biops y and autopsy demonstrated platelet/fibrin thrombi, marked interstitial neu trophilia, alveolar edema, and antibody deposition on the endothelial surfa ce and vasculature walls. Prior to the first transplant, the patient's seru m had 0% panel reactive antibody and was crossmatch compatible with the fir st 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 pat hologic features of hyperacute rejection in a lung allograft which are simi lar to those seen with other organ allografts.