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. 1968 Mar 21;278(12):642-8.
doi: 10.1056/NEJM196803212781202.

Shwartzman reaction after human renal homotransplantation

T E Starzl, R A Lerner, F J Dixon, C G Groth, L Brettschneider, P I Terasaki

Shwartzman reaction after human renal homotransplantation

T E Starzl et al. N Engl J Med. .

Abstract

In three human recipients, five renal homografts were destroyed within a few minutes to hours after their revascularization in the new host. The kidneys, removed one to 54 days later, had cortical necrosis. The major vessels were patent, but the arterioles and glomeruli were the site of fibrin deposition. There was little or no fixation of host immunoglobulins in the homografts. The findings were characteristic of a generalized Shwartzman reaction.

Although the cause (or causes) of the Shwartzman reaction in our patients is not known, they may have been conditioned by the bacterial contamination and hemolysis that often attend hemodialysis, by immunosuppression and by the transplantation itself. Some of the patients have preformed lymphocytotoxic antibodies. Thus, certain patients may be predisposed. High-risk patients should be recognized and treated prophylactically with anticoagulants.

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Figures

FIGURE 1
FIGURE 1
Glomerulus from the second Homograft Removed form Case 1, Phosphotungstic Acid (Hematoxylin stain X350). Note the heavy deposition of fibrin in this glomerulus.
FIGURE 2
FIGURE 2
Glomerulus From the First Homograft Removed From Case 1 (Hematoxylin and Eosin stain X350). Note the intravascular thrombi (arrows) and the marked infiltration of polymorphonuclear leukocytes into this glomerulus.
FIGURE 3
FIGURE 3
Glomerulus from the first Homograft Removed form Case 1, Two days after Transplantation, and Stained for Fibrin (X400). In this glomerulus most of the fibrin is deposited along the glomerular basement membranes.
FIGURE 4
FIGURE 4
Glomerulus form the Homograft Removed form Case 2 and Stained for Fibrin (X350). Note that deposition of fibrin is much heavier than that in the glomerulus shown in Figure 3 and that almost all the glomerular capillaries are occluded with fibrin.
FIGURE 5
FIGURE 5
Glomerulus (Stained for Fibrin) from the second Homograft Removed from Case 1. 18 Days after Transplantation. Showing Complete obliteration of the Glomerular Architecture with fibrin (X300).
See this image and copyright information in PMC

References

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