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General Medicine · Nephrology: renal transplant rejection
Sample itemWithin minutes of reperfusion of a transplanted kidney, the graft becomes mottled and cyanotic. What is the mechanism?
Original practice item, not a recalled exam question. Nothing here is recorded.
The answer and the reasoning
B. Hyperacute rejection from preformed antibodies
Hyperacute rejection occurs within minutes to hours from preformed anti-donor antibodies, such as ABO or HLA antibodies, causing complement-mediated vascular thrombosis. It is prevented by cross-matching. Acute cellular rejection occurs weeks to months later and responds to steroids.
Option by option
A. Calcineurin inhibitor toxicity
Drug toxicity does not cause immediate mottling at reperfusion.
B. Hyperacute rejection from preformed antibodies (correct)
Correct. Preformed antibodies cause immediate graft loss.
C. Acute cellular rejection from T cells
Acute cellular rejection takes days to months.
D. Chronic allograft nephropathy
Chronic nephropathy takes years.
Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.
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