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Clin Transplant. 1989;3:37-45.

Evidence for hyperacute rejection of human liver grafts: The case of the canary kidneys.

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Departments of Surgery, Pathology, and Anesthesiology, University Health Center of Pittsburgh, University of Pittsburgh, the Veterans Administration Medical Center, Pittsburgh, PA and the Department of Pathology, St. Mary's Hospital and Medical School, London, U.K.


Sequential liver and kidney transplantation from the same donor was performed in 2 patients. The kidney in Patient 1, which was transplanted after the liver, was hyperacutely rejected and removed 6 hours later. The first liver as well as another liver transplanted 3 days later developed widespread hemorrhagic necrosis. Although the cytotoxic crossmatch of preoperative recipient serum with both donors was negative, patchy widespread IgM and C(1q) deposits were found in all 3 organs. In Patient 2, who had a strongly positive cytotoxic crossmatch with his donor, the liver suffered a massive but reversible injury, while the kidney never functioned. Both patients developed a coagulopathy a few minutes after liver revascularization. The kidneys in these cases had served like the canaries which miners once used to detect a hostile environment and their presence made more understandable how an indolent version of hyperacute rejection of the liver can take place.


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