Coagulation Studies in the Hyperacute and Other Forms of Renal-Allograft Rejection

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Abstract
Nine renal-allograft recipients were studied for consumption coagulopathy and fibrinolysis, which should be present if rejection is associated with the generalized Shwartzman phenomenon. One of two patients with hyperacute rejections had renal arterial and venous blood sampled during transplant nephrectomy. Peripheral blood samples from three patients with acute and one with hyperacute rejections were examined before and after transplantation. Serial observations of fibrinogen, platelets and factors II, V and VIII failed to show consumption coagulopathy in either hyperacute or acute rejections despite morphologic and immunohistochemical evidence of extensive renal cortical vascular thrombosis. Euglobulin lysis times, plasminogen levels and fibrinogen split products did not provide evidence for systemic fibrinolysis. In one patient with chronic refractory rejection, renal venous blood contained small amounts of fibrinogen split products, suggesting localized fibrinolysis.