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Review
. 2022 Sep 9;101(36):e30493.
doi: 10.1097/MD.0000000000030493.

Plasma cell-rich related acute rejection in kidney transplant: A case report and review of the literature

Yao-Yu Tsai  1 , Lee-Moay Lim  2   3 , Hung-Tien Kuo  2   3 , Yi-Chun Tsai  2   3   4
Affiliations
Review

Plasma cell-rich related acute rejection in kidney transplant: A case report and review of the literature

Yao-Yu Tsai et al. Medicine (Baltimore). .

Abstract

Rationale: Plasma cell-rich acute rejection (PCAR), a subtype of T cell-mediated rejection, is a relatively rare type of acute allograft rejection, that is usually associated with a higher rate of graft failure. However, it is difficult to diagnose PCAR precisely.

Patient concerns: A 45-year-old woman who had received a kidney transplant presented with acute kidney injury and uremic symptoms approximately 1 year after transplantation.

Diagnosis: A renal biopsy was performed and pathological examination revealed marked inflammation with abundant plasma cells in areas within interstitial fibrosis and tubular atrophy. The patient was diagnosed with PCAR and chronic active T cell-mediated rejection (CA-TCMR) grade IA.

Interventions: Immunosuppressants were administered as tacrolimus (2 mg twice daily), mycophenolate mofetil (250 mg twice daily), and prednisolone (15 mg/day) for suspected PCAR.

Outcomes: The patients showed rapid deterioration in kidney function and reached impending graft failure.

Lessons: PCAR is often associated with poor graft outcome. The high variability in tacrolimus levels could contribute to poor patient outcomes, leaving aggressive immunosuppressive therapy as the remaining choice for PCAR treatment.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1.
Figure 1.
Immunohistochemistry. (A) Infiltration with plasma cell and monocyte examined using hematoxylin and eosin H&E staining (400×). (B) Moderate tubulitis lesion detected by H&E staining (200×). (C) T-lymphocytes infiltration in interstitium, tubules and glomeruli using CD3 staining (brown, 50×). (D) plasma cell scattered in tubules and peritubular area detected by CD138 staining (brown, 100×). CD = cluster of differentiation, H&E = hematoxylin and eosin.
Figure 2.
Figure 2.
Summary of clinical course with treatment regimen, serum creatinine, and FK506 trough level in this patient. *: The patient had 2 weeks use of 15 mg/d prednisolone after PCAR and CA-TCMR was diagnosed. CA-TCMR = chronic active T cell-mediated rejection, PCAR = plasma cell-rich acute rejection, Pred = prednisolone.
See this image and copyright information in PMC

References

    1. Mubarak M, Abbas K, Zafar MN, et al. . Immunohistopathologic characterization of plasma cell-rich acute rejection in living-related renal transplant recipients. Exp Clin Transplant. 2017;15:516–20. - PubMed
    1. Gartner V, Eigentler TK, Viebahn R. Plasma cell-rich rejection processes in renal transplantation: morphology and prognostic relevance. Transplantation. 2006;81:986–91. - PubMed
    1. Rodrigues CA, Franco MF, Cristelli MP, et al. . Clinicopathological characteristics and effect of late acute rejection on renal transplant outcomes. Transplantation. 2014;98:885–92. - PubMed
    1. Adrogue HE, Soltero L, Land GA, et al. . Immunoglobulin therapy for plasma cell-rich rejection in the renal allograft. Transplantation. 2006;82:567–9. - PubMed
    1. Charney DA, Nadasdy T, Lo AW, et al. . Plasma cell-rich acute renal allograft rejection. Transplantation. 1999;68:791–7. - PubMed