Step 1: Hyperacute rejection is the fastest form of graft rejection, occurring within minutes of vascular anastomosis, often while the patient is still on the operating table.
Step 2: It is mediated by pre-formed recipient antibodies, classically against mismatched ABO blood group antigens on the donor endothelium. These antibodies bind immediately, activate complement and the clotting cascade, and cause thrombosis and ischaemic destruction of the graft.
Step 3: By contrast, acute rejection takes days to weeks and chronic rejection takes months to years. Therefore the correct timing for hyperacute rejection is in minutes.