Hyperacute Rejection After Lung Transplantation Caused by Undetected Low-titer Anti-HLA Antibodies

Pathology of pulmonary antibody-mediated rejection: 2012 update from the Pathology Council of the ISHLT

“…After the 1996 revised ISHLT report, case reports documenting clinical, serologic and/or morphologic findings in hyperacute rejection appeared in the literature. [22][23][24][25][26][27] The histologic findings included alveolar edema, hemorrhage, fibrin accumulations, hyaline membranes, intravascular platelet/fibrin thrombi, interstitial and intraalveolar neutrophilic infiltrates and focal arteriolar fibrinoid necrosis. The degree of neutrophilic infiltration of alveolar septa ranged from patchy and mild to florid in the reported cases.…”

Acute Antibody-mediated Rejection After Lung Transplantation

“…6 -8 In addition, the role of pre-formed donor-specific antibodies in hyperacute rejection after lung transplantation has been well recognized. 9 However, acute antibody-mediated lung rejection has not been well documented. In the latest International Society for Heart and Lung Transplantation revision of the nomenclature of lung rejection, there was no consensus on the histologic hallmarks of antibody-mediated rejection.…”

Successful lung transplantation in the presence of pre-existing donor-specific cytotoxic HLA Class II antibodies

“…In most of the documented cases hyperacute rejection was caused by pre-existing donor-specific HLA Class I antibodies. 7,[9][10][11] Three studies reported (hyper)acute rejection due to donor-specific Class II antibodies. 5,23,24 A recent case report showed hyperacute rejection due to antibodies against DQA1 molecules leading to transplant failure and death of the patient, indicating that anti-DQ antibodies can be damaging to a lung allograft.…”