Fatal peri-operative hyperacute graft rejection during heart transplantation related to infusion of red blood cell concentrate

With the use of sensitive new technology, hyperacute graft rejection is currently reported as an extremely rare event due to prospective lymphocyte crossmatches and/or virtual crossmatches. In this case study we describe a case of fatal early graft failure after a cardiac transplant in a male recipient who had no anti-HLA antibodies detected before transplantation, but who received, during heart transplant surgery, a red blood cell concentrate containing high levels of graft-specific alloantibodies. In addition, we analyze the relationship between these alloantibodies and the occurrence of hyperacute allograft rejection.