Which microscopic findings are characteristic of antibody-mediated lung transplantation rejection?

Updated: Jun 06, 2019
  • Author: Aliya N Husain, MBBS, MD; Chief Editor: Philip T Cagle, MD  more...
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Antibody-mediated rejection

Antibody-mediated rejection, also called humoral or hyperacute rejection, is not included in the ISHLT classification owing to the scarcity of reports in the literature. There is no consensus on its recognition and diagnosis by either histopathologic or immunologic methods, nor on its significance and treatment.

Antibody-mediated rejection is characterized by the activation of inflammatory pathways along with the complement and coagulation cascades due to the binding of preformed antibody to endothelial cells. Progressive respiratory failure within minutes to hours after transplantation suggests antibody-mediated rejection. It is also thought to occur weeks or months after transplantation upon development of serum antibodies. Histologic evaluation reveals diffuse alveolar damage (DAD), fibrin thrombi, vasculitis, intraalveolar hemorrhage, and interstitial neutrophilia.

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