Hyperacute rejection of a kidney allograft may be caused by cytotoxic lymphocytes

A case of hyperacute rejection of a kidney allograft is described in relation to the clinical, patho-anatomical, and immunological findings. An 18-year-old male was allotransplanted for the third time with a necrokidney from an unrelated HLA-A and B, full house identical and blood group ABO identical donor. Serological crossmatches performed with recipient sera harvested before and after transplantation were negative. In spite of this, the kidney suffered hyperacute rejection according to clinical and patho-anatomical criteria. The cellular, complement independent cytolytic capacity of recipient lymphocytes drawn before and after transplantation against donor lymphocytes was tested by the direct Cell Mediated Lympholysis (CML) test. This test was positive 24 hours after transplantation, whereas it had been negative before this. Lymphocytolysis was enhanced by inactivated recipient serum harvested before and after transplantation. These findings suggest that hyperacute rejection of a kidney allograft may be ascribed to presensitized, not necessarily circulating, effector lymphocytes either alone, or in concert with antibody(ies) not disclosed by conventional crossmatching.