Immunoglobulin Therapy for Plasma Cell-Rich Rejection in the Renal Allograft

Abstract

Plasma cell-rich acute rejection (PCAR) is associated with poor allograft outcome in renal transplantation. Previous studies report a graft half-life of six months after a single PCAR episode. However, the management of this condition is unclear. Intravenous immunoglobulin (IVIG) therapy, by virtue of its immunomodulating properties, and its influence on B-cell maturation into plasma cells, may be a good candidate for reversing this type of rejection. We report four episodes of PCAR in two patients who responded well to IVIG with improvement in renal function.

Immunephenotype of Glomerular and Interstitial Infiltrating Cells in Protocol Renal Allograft Biopsies and Histological Diagnosis

“…The number of interstitial infiltrating macrophages is associated with the presence of IF/TA in protocol biopsies (29) and the number of glomerular infiltrating macrophages in patients with acute rejection is associated with a poor outcome that is independent from peritubular capillary C4d deposition (30,31). In the present study, the number of glomerular infiltrating macrophages was higher in patients with SCR and IF/TA but was not significantly different from patients displaying SCR without IF/TA.…”

Renal allografts in plasma cell myeloma hematopoietic cell graft recipients: on the verge of an explosion?

“…[46][47][48] Although current data suggest that plasma cells have an important role in graft rejection, there are concerns that presently used protocols do not target these cells. 49,50 Bortezomib, a proteasome inhibitor used in the therapy of PCM, depletes plasma cells and has been utilized by several transplant groups for treatment of Abmediated rejection. 48 Bortezomib also exerts indirect effects on circulating B and T H cells.…”

The significance of plasma cell infiltrate in acute cellular rejection of liver allografts

“…Plasma cell-rich acute rejection (PCAR), characterized by the presence of more than 10% mature plasma cells in the inflammatory cell infiltrate, develops in approximately 5% of the renal allografts with biopsy-proven acute rejection [6,7]. PCAR in this clinical setting is associated with poor outcome, suboptimal response to conventional immunosuppressant therapy, and a need for alternative modalities of treatment such as intravenous immunoglobulins (Ig) [6,[8][9][10]. In addition, the presence of donor-specific IgG anti-human leukocyte antigen antibody has been found to be associated with increased risk of acute rejection, more severe rejection, and lower graft survival in the affected renal allografts [11,12].…”