Overview
Hyperacute rejection is a rapid and severe form of organ transplant rejection that occurs within minutes to hours after reperfusion of the transplanted organ. It is typically mediated by preformed antibodies against donor antigens.Diagnosis
Diagnosis is primarily clinical, based on the rapid onset of graft dysfunction and signs of ischemia shortly after transplantation 1.
No specific grading system for hyperacute rejection is mentioned in the provided abstracts.Management
Management of hyperacute rejection typically involves immediate removal of the offending organ to prevent further damage and systemic complications 1.
Prophylaxis with a combination therapy of a calcineurin inhibitor (preferably tacrolimus), mycophenolate, and steroids is recommended for initial rejection prophylaxis 1.Key Recommendations
Initial rejection prophylaxis should be performed with a combination therapy of a calcineurin inhibitor (preferably tacrolimus), mycophenolate, and steroids 1. (Evidence: Strong)
Decisions regarding the acceptance of a donor organ should not be based on histological findings alone 1. (Evidence: Strong)
A Lich-Gregoir-like extravesical technique for ureterovesical anastomosis, protected by a ureteral stent, is the preferred technique 1. (Evidence: Strong)References
1 Faba OR, Boissier R, Budde K, Figueiredo A, Hevia V, García EL et al.. European Association of Urology Guidelines on Renal Transplantation: Update 2024. European urology focus 2025. link