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Subjects/Pathology/Transplant Rejection
Transplant Rejection
medium
microscope Pathology

A 45-year-old male undergoes a kidney transplant. Within minutes of reperfusion, the transplanted kidney becomes cyanotic, flaccid, and fails to produce urine. Histopathological examination would most likely reveal:

A. A. Widespread thrombosis of graft vasculature
B. B. Dense perivascular lymphocytic infiltrate
C. C. Extensive interstitial fibrosis and tubular atrophy
D. D. Granulomatous inflammation with giant cells

Explanation

This clinical presentation is classic for hyperacute rejection, which occurs minutes to hours after transplantation. It is mediated by pre-formed antibodies (e.g., ABO antibodies or anti-HLA antibodies) in the recipient's circulation that bind to donor endothelial antigens, activating complement and coagulation cascades. This leads to widespread thrombosis, ischemic necrosis, and graft failure. Options B, C, and D are characteristic of acute cellular rejection, chronic rejection, and specific infections/inflammatory conditions, respectively.

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