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Case Reports in Medicine
Volume 2014, Article ID 613641, 4 pages
http://dx.doi.org/10.1155/2014/613641
Case Report

Hyperacute Rejection of a Living Unrelated Kidney Graft

1Department of General and Visceral Surgery, University of Freiburg, Hugstetter Straße 55, 79106 Freiburg im Breisgau, Germany
2Department of General Surgery, University Hospital Lübeck, University of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
3Institute of Pathology, University of Freiburg, Breisacher Straße 115a, 79106 Freiburg im Breisgau, Germany
4Department of Transfusion Medicine, University of Freiburg, Hugstetter Straße 55, 79106 Freiburg im Breisgau, Germany
5Department of Nephrology, University of Freiburg, Hugstetter Straße 55, 79106 Freiburg im Breisgau, Germany

Received 1 July 2014; Revised 26 August 2014; Accepted 26 August 2014; Published 17 September 2014

Academic Editor: Tobias Keck

Copyright © 2014 Dietlind Tittelbach-Helmrich et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

We present a case report of a 59-year-old man, who received a blood group identical living unrelated kidney graft. This was his second kidney transplantation. Pretransplant T-cell crossmatch resulted negative. B-cell crossmatch, which is not considered a strict contraindication for transplantation, resulted positive. During surgery no abnormalities occurred. Four hours after the transplantation diuresis suddenly decreased. In an immediately performed relaparotomy the transplanted kidney showed signs of hyperacute rejection and had to be removed. Pathological examination was consistent with hyperacute rejection. Depositions of IgM or IgG antibodies were not present in pathologic evaluation of the rejected kidney, suggesting that no irregular endothelial specific antibodies had been involved in the rejection. We recommend examining more closely recipients of second allografts, considering not only a positive T-cell crossmatch but also a positive B-cell crossmatch as exclusion criteria for transplantation.