Editing Transplant rejection (section)

===Hyperacute rejection===

'''Hyperacute rejection''' is a form of rejection that manifests itself in the minutes to hours following transplantation.<ref name=":1">{{cite book | vauthors = Chang YC | chapter = The surgical and immunosuppressive basis for infections in the pediatric solid organ transplant recipient |date=2021-01-01 | doi = 10.1016/B978-0-323-64198-2.00010-5 | title = Pediatric Transplant and Oncology Infectious Diseases |pages=1–9.e3 | veditors = Steinbach WJ, Green MD, Michaels MG, Danziger-Isakov LA  |place=Philadelphia |publisher=Elsevier |language=en |isbn=978-0-323-64198-2 | s2cid = 228907807 }}</ref> It is caused by the presence of pre-existing [[Antibody|antibodies]] in the recipient that recognize [[antigen]]s in the donor organ.<ref>{{cite book | vauthors = Harmon WE | chapter = Chapter 41 - Pediatric Renal Transplantation |date=2010-01-01 | doi = 10.1016/B978-1-4377-0987-2.00041-8 | title = Chronic Kidney Disease, Dialysis, and Transplantation | edition = Third |pages=591–608 | veditors = Himmelfarb J, Sayegh MH |place=Philadelphia |publisher=W.B. Saunders |language=en |isbn=978-1-4377-0987-2 }}</ref> These antigens are located on the endothelial lining of blood vessels within the transplanted organ and, once antibodies bind, will lead to the rapid activation of the [[complement system]].<ref name=":2">{{cite book | chapter = Chapter 17 - Transplantation |date=2014-01-01 |doi = 10.1016/B978-0-12-385245-8.00017-0 | title = Primer to the Immune Response | edition = Second |pages=457–486 | veditors = Mak TW, Saunders ME, Jett BD | location = Boston |publisher=Academic Cell |language=en |isbn=978-0-12-385245-8 }}</ref> Irreversible damage via thrombosis and subsequent graft necrosis is to be expected.<ref>{{cite book | vauthors = Dharnidharka VR | chapter = 43 - Pediatric Renal Transplantation |date=2019-01-01 |doi = 10.1016/B978-0-323-52978-5.00043-4 | title = Chronic Kidney Disease, Dialysis, and Transplantation | edition = Fourth |pages=661–675.e7 | veditors = Himmelfarb J, Ikizler TA |place=Philadelphia |publisher=Elsevier |language=en |isbn=978-0-323-52978-5 | s2cid = 81475473 }}</ref> Tissue left implanted will fail to work and could lead to high fever and malaise as the immune system acts against foreign tissue.<ref name=":4">{{cite book | vauthors = Vitak K | chapter = Chapter 14 - Organ Transplantation |date=2014-01-01 | doi = 10.1016/B978-1-4557-2896-1.00014-7 | title = Acute Care Handbook for Physical Therapists | edition = Fourth |pages=335–356 | veditors = Paz JC, West MP |place=St. Louis |publisher=W.B. Saunders |language=en |isbn=978-1-4557-2896-1 }}</ref>

{{main|ABO-incompatible transplantation}}

Graft failure secondary to hyperacute rejection has significantly decreased in incidence as a result of improved pre-transplant screening for antibodies to donor tissues.<ref name=":1" /> While these preformed antibodies may result from prior transplants, prior blood transfusions, or pregnancy, hyperacute rejection is most commonly from antibodies to [[ABO blood group system|ABO blood group]] antigens.<ref name=":2" /> Consequently, transplants between individuals with differing ABO blood types is generally avoided though may be pursued in very young children (generally under 12 months, but often as old as 24 months)<ref name="West_2001">{{cite journal | vauthors = West LJ, Pollock-Barziv SM, Dipchand AI, Lee KJ, Cardella CJ, Benson LN, Rebeyka IM, Coles JG | title = ABO-incompatible heart transplantation in infants | journal = The New England Journal of Medicine | volume = 344 | issue = 11 | pages = 793–800 | date = March 2001 | pmid = 11248154 | doi = 10.1056/NEJM200103153441102 | doi-access = free }}</ref> who do not have fully developed immune systems.<ref name="pmid21836514">{{cite journal | vauthors = West LJ | title = ABO-incompatible hearts for infant transplantation | journal = Current Opinion in Organ Transplantation | volume = 16 | issue = 5 | pages = 548–554 | date = October 2011 | pmid = 21836514 | doi = 10.1097/MOT.0b013e32834a97a5 | s2cid = 26070409 }}</ref> Shortages of organs and the morbidity and mortality associated with being on transplant waitlists has also increased interest in ABO-incompatible transplantation in older children and adults.<ref>{{cite journal | vauthors = Subramanian V, Ramachandran S, Klein C, Wellen JR, Shenoy S, Chapman WC, Mohanakumar T | title = ABO-incompatible organ transplantation | journal = International Journal of Immunogenetics | volume = 39 | issue = 4 | pages = 282–290 | date = August 2012 | pmid = 22339811 | doi = 10.1111/j.1744-313x.2012.01101.x | s2cid = 41947505 | doi-access = free }}</ref>