Transplant rejection and graft-versus-host disease
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A 46-year-old who has received several blood transfusions undergoes kidney transplantation. The kidney initially becomes pink after blood flow is restored but becomes mottled and produces almost no urine within 25 minutes. The surgical arterial and venous connections are patent. A biopsy shows endothelial injury, extensive platelet-fibrin thrombi in small vessels, and immunoglobulin and complement along the microvasculature.