Plasma Cell–Rich Rejection After Kidney Transplantation and the Role of Donor-Specific Antibodies: A Case Report and Review of the Literature

Hasegawa, Jumpei; Honda, Kazuho; Wakai, Sachiko; Shirakawa, Hiroki; Omoto, Kazuya; Okumi, Masayoshi; Ishida, Hideyuki; Tanabe, Kazunari

doi:10.1016/j.transproceed.2015.09.018

Cited by 12 publications

(8 citation statements)

References 18 publications

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“…Recently several investigators have reported PCRR cases associated with antibody component and suggested that PCRR represents a prototype of AAMR or combined type of ATCR and AAMR . In our study, there were no significant differences in ATCR type based on the Banff classification and frequency of complicating AAMR between PCRRs and ATCRs.…”

Section: Discussioncontrasting

confidence: 58%

“…Although PCRR has been considered a subtype of ATCR, methylprednisolone pulse (mPSL), a standard regimen for ATCR, is not usually adequately effective in cases of PCRR. Moreover, recent studies have suggested the distinctive characteristics of PCRR that differ from those of ATCR including long post‐transplant duration prior to rejection, poor graft survival and probable association with antibody components . Ultimately, PCRR is recognised as a refractory rejection and no ideal treatment for PCRR has been established.…”

Section: Discussionmentioning

confidence: 99%

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Clinicopathological and immunohistochemical analysis of plasma cell‐rich rejection in renal transplantation: Involvement of intratubular Th1/Th2 balance in plasma cell enrichment

et al. 2018

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Section: Discussioncontrasting

confidence: 58%

Section: Discussionmentioning

confidence: 99%

Clinicopathological and immunohistochemical analysis of plasma cell‐rich rejection in renal transplantation: Involvement of intratubular Th1/Th2 balance in plasma cell enrichment

et al. 2018

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“…PCRR typically occurs one or more years after transplantation. Although PCRR has been generally considered to be a subtype of T cell–mediated rejection (TCMR), cases of florid plasma cell infiltration have been reported in association with late antibody‐mediated rejection (ABMR) . Similar to our case, the infiltrated plasma cells in this variant of ABMR are mature and polyclonal, as verified by expression of both kappa and lambda light chains by immunohistochemistry.…”

Section: Discussionsupporting

confidence: 80%

Recurrent IgG4-related tubulointerstitial nephritis concurrent with chronic active antibody mediated rejection: A case report

Chibbar

Wright

Dokouhaki

et al. 2018

American Journal of Transplantation

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IgG4-related disease is a relatively newly described entity that can affect nearly any organ, including the kidneys, where it usually manifests as tubulointerstitial nephritis (IgG4-TIN). The diagnosis can be suggested by characteristic histological features, including an inflammatory infiltrate with increased IgG4-positive plasma cells associated with "storiform" fibrosis. Serum IgG4 is usually elevated. In the native kidney and other organs, there is typically a brisk response to treatment with immunosuppression. Recurrence of IgG4-TIN after renal transplant has not been described in the literature. Here, we describe the first case of recurrent IgG4-TIN in a young patient concomitant with chronic active antibody mediated rejection five years after kidney transplant. Recurrent IgG4-TIN could be diagnosed by the characteristic histopathologic features and increased IgG4-positive plasma cells. Despite maintenance immunosuppression, this disease may recur in the kidney allograft.

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“…7 Recent literature also suggested that detection of donorspecific antibodies (DSA) might be useful in determining whether the PCAR is of a subtype of AMR, which can be refractory to immunosuppression treatment with unfavorable outcome. 3,6 In our case, however, DSA detection was not available in view of unknown donor profile.…”

Section: Discussionmentioning

confidence: 79%

Plasma cell-rich acute rejection of renal allograft: an unusual case of acute allograft dysfunction

Lee

Thangaraju

Ahmed

et al. 2016

Proceedings of Singapore Healthcare

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We report a case of renal allograft dysfunction due to plasma cell-rich acute rejection (PCAR), which is an uncommon clinical entity with a wide range of differential diagnoses. Extensive diagnostic workup, treatment approach and outcome are discussed and we provide a brief summary of the current management dilemma. Nevertheless, the diagnosis of PCAR portends a poor prognosis and therefore timely diagnosis and intensification of treatment is crucial to prevent disease progression.

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Plasma Cell–Rich Rejection After Kidney Transplantation and the Role of Donor-Specific Antibodies: A Case Report and Review of the Literature

Cited by 12 publications

References 18 publications

Clinicopathological and immunohistochemical analysis of plasma cell‐rich rejection in renal transplantation: Involvement of intratubular Th1/Th2 balance in plasma cell enrichment

Clinicopathological and immunohistochemical analysis of plasma cell‐rich rejection in renal transplantation: Involvement of intratubular Th1/Th2 balance in plasma cell enrichment

Recurrent IgG4-related tubulointerstitial nephritis concurrent with chronic active antibody mediated rejection: A case report

Plasma cell-rich acute rejection of renal allograft: an unusual case of acute allograft dysfunction

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