In what types of transplant rejections do fibrinoid necrosis occur? First Aid('07) says it occurs in chronic rejection but Robbins says hyperacute. Or does it happen in both, which would make sense since they're both antibody-mediated.
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Step I transplant rejection pathophys
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I think fibrosis occurs in just chronic.
Hyperacute = type II hypersensitivty reaction, usually b/c of ABO incompatibility or preformed anti-HLA Ab. I believe the pathologic finding is thrombosis. [read this chapter in Goljan a few days ago.. Ch 3 I believe]
If it's presented as occuring from either, I would go with either being contributing factors.
However, that being said, if I had to choose between the two, I would go with chronic rejection being an etiologic factor to (immune-mediated) fibrinoid necrosis. This is in part due to fibrinous reactions taking weeks to develop in immune dysfunction- as in dresslers fibrinous pericarditis (immune-system-mediated), which takes several weeks to develop post-MI, vs. non-dresslers (which is not immune-mediated) fibrinous pericarditis, which develops just several days post-MI.
Fibrinoid necrosis I believe usually refers to an acute destruction of blood vessal walls, as in hyperacute rejection. (A pinkish sloughing inside the lumen on pathology.) But it's been a while so don't quote me. Chronic rejection usually has changes to parenchymal tissue (fibrosis of), but I'm not sure if you see fibrinoid necrosis of blood vessals...you probably see thickening of vessal walls (at least in chronic rejection of kidneys) instead.
