Early fulminant liver allograft failure is a post-transplant syndrome presenting as massive haemorrhagic
necrosis of the graft. A single organ
Shwartzman reaction has previously been suggested as a cause. We report on a patient who lost her liver graft due to fulminant graft failure ten days after orthotopic
liver transplantation (OLT), the liver showing massive haemorrhagic
necrosis. Fresh
thrombosis was noted in the portal and hepatic veins. As a
Shwartzman reaction could be expected to lead to
complement deposition in vessel walls, tissue was analyzed for the presence of
complement components. However, even though
protein-rich and
fibrinogen-containing deposits were detected within the vessel walls, these deposits were not immunoreactive for
complement (C3 and Clq). These findings suggest that pathogenesis of fulminant liver allograft failure differs from that of a
complement-mediated
Shwartzman reaction, or of a hyperacute rejection, where
IgM and Clq had previously been detected in hepatic veins and arteries.