What immediate sign might indicate hyperacute transplant rejection?

Hyperacute transplant rejection occurs almost immediately after transplant, often within minutes to hours. The underlying mechanism involves preformed antibodies in the recipient's blood reacting against donor antigens, leading to rapid complement activation and endothelial damage.

The immediate sign that indicates hyperacute rejection is graft duskiness or mottling. This refers to the discoloration of the transplanted organ, which may appear bluish or mottled due to inadequate blood supply as a consequence of vascular obstruction from the rejection process. The appearance of the graft changes quickly because the process is so rapid, making it a prominent indicator.

While the other options could be associated with various complications after a transplant, they do not specifically indicate hyperacute rejection. Bruising might happen due to other factors such as surgical technique or anticoagulation. Persistent pain could arise from different issues unrelated to rejection, such as infection or surgical complications. Fever is a general sign of infection or inflammation and isn't specific to hyperacute rejection; it may be seen in other transplant-related issues, including acute rejection or infection. Thus, graft duskiness/mottling stands out as the hallmark of hyperacute rejection in this context.