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Plasma Cell-Rich Acute Rejection in Renal Transplantation: A Case Report.

Abstract：

:Plasma cell-rich acute rejection (PCAR) is a rare type of allograft rejection in renal transplantation. It is characterized by the presence of mature plasma cells that compromise more than 10% of inflammatory cells infiltrating the renal graft. The pathogenesis of PCAR is unknown, appears late, and has been related mainly to insufficient immunosuppression or infections. The treatment is not clearly defined, and the graft survival is poor. Here, we report a case series of 3 Spanish patients diagnosed with PCAR accompanied by donor-specific antibodies (DSA) after kidney transplantation. Mean to diagnosis was 2-12 years post-transplantation, and they began with abrupt deterioration of renal function. All patients were women and had preceding viral infection. In addition, two of the three patients recognize a doubtful adherence to immunosuppression. About treatment, 2 of the 3 patients, because the biopsy of the renal graft showed signs suggestive of incipient antibody-mediated rejection (ABMR) (glomerulitis, capilaritis, transplant glomerulopathy), were started with corticosteroids, anti-thymoglobulin, plasmapheresis, and intravenous immunoglobulins. The last patient, who only showed PCAR at biopsy, was treated with corticosteroids and anti-thymoglobulin. After treatment, graft function improved in all of them, but one patient developed an ABMR and another required a dialysis program, all of which indicates the difficulty in management and treatment of PCAR.

journal_name

Transplant Proc

journal_title

Transplantation proceedings

authors

Plaza Lara E,Hernández García E,Ruiz Fuentes MDC,Caba Molina M,De Gracia Guindo MDC,Osuna Ortega A

doi

10.1016/j.transproceed.2019.12.015

subject

Has Abstract

pub_date

2020-03-01 00:00:00

pages

512-514

issue

2

eissn

0041-1345

issn

1873-2623

pii

S0041-1345(19)31198-4

journal_volume

52

pub_type

杂志文章

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