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Understanding the pathogenesis and the pathology of hyperacute cardiac rejection

Alan G Rose1

  • 1Department of Laboratory Medicine and Pathology, University of Minnesota Medical School and Fairview-University Medical Center, MMC 76, 420 Delaware Street SE, Minneapolis, MN 55455, USA. rosex031@tc.umn.edu

Cardiovascular Pathology : the Official Journal of the Society for Cardiovascular Pathology
|May 29, 2002
PubMed

Insights

The term hyperacute rejection (HAR) is outdated. Researchers recommend using HAR for antibody-mediated rejection within 24 hours, recognizing venous thrombosis

Area of Science:

  • Transplantation immunology
  • Pathology
  • Nephrology

Background:

  • The term hyperacute rejection (HAR) is outdated and confusing due to advances in delaying its onset and numerous synonyms.
  • Existing terminology does not adequately classify antibody-mediated xenograft rejection based on causative antibodies.

Purpose of the Study:

  • To propose revised terminology for antibody-mediated rejection in transplantation.
  • To clarify the definition and timing of hyperacute rejection.
  • To emphasize the role of venous thrombosis in HAR pathogenesis.

Main Methods:

  • Review of current literature on hyperacute rejection and xenograft rejection.
  • Analysis of pathological findings in transplanted organs, particularly the heart.
  • Pathological interpretation based on the role of venous thrombosis in obstructed venous drainage.

Main Results:

  • Recommended applying the term hyperacute rejection (HAR) to antibody-mediated rejection occurring within 24 hours.
  • Identified delayed HAR as the same pathological process occurring after 24 hours.
  • Highlighted the significance of venous thrombosis in HAR pathogenesis and its impact on interpreting organ biopsies.

Conclusions:

  • The term hyperacute rejection (HAR) should be reserved for antibody-mediated rejection within 24 hours.
  • Understanding venous thrombosis is crucial for interpreting HAR pathology in biopsies.
  • A future grading system for HAR may be possible with advancements in xenografting.

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