Hyperacute rejection of renal homografts: with particular reference to coaglation changes, humoral antibodies, and formed blood elements.

The evaluation of human histocompatibility matching in renal transplant recipients has not been possible with anything like the precision of a controlled laboratory experiment. One reason has been that varying degrees of patient presensitization may occur to antigens present in the eventual organ donor. The consequence of this unfavorable condition may be accelerated or even hyperacute rejection in spite of an apparently good histocompatibility match. In recent years, increasing numbers of human renal homografts have been lost by hyperacute rejection. Although much has been learned about the complication, several aspects of its pathogenesis have remained unclear either because of seemingly contradictory reports in the clinical literature or because of insufficient experimental information about the interlocking roles of humoral antibodies, coagulation, and formed blood elements in the process of destruction. Consequently, this paper will attempt to clarify the existing state of knowledge about hyperacute rejection by presenting a historical review of the subject and by describing several laboratory experiments designed to provide detailed data about the very earliest events of this form of graft destruction.