Before a deceased donor kidney transplant, a complement-dependent cytotoxicity crossmatch is performed using recipient serum and donor lymphocytes. A positive crossmatch predicts which complication if transplantation proceeds?

• A Delayed graft function from acute tubular necrosis
• B Hyperacute rejection within minutes of reperfusion ✓
• C Chronic allograft nephropathy at 5 years
• D Recurrent primary glomerular disease in the graft

Explanation

The crossmatch detects preformed circulating recipient antibodies directed against donor HLA antigens expressed on donor cells. Transplantation across a positive T cell crossmatch risks hyperacute rejection, with antibody binding antigen, complement activation, endothelial injury, thrombosis and immediate graft loss. Delayed graft function relates to ischaemia-reperfusion injury and is not predicted by serology, and recurrent disease appears years later with a different histology.

Reference: Sabiston Textbook of Surgery, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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