title: Renal graft loss with plasma cell-rich acute rejection in cadaveric renal transplantation: a case report.
abstract: We reported a case of renal graft loss in cadaveric renal transplantation. An episode biopsy with renal dysfunction showed plasma cell predominant inflammatory infiltration in the interstitium without a finding of vascular or glomerular rejection, and was diagnosed as plasma cell-rich acute rejection (PCAR). Despite intensive immunosuppressive therapy, the renal histology of repeated biopsies showed persistent plasma cell infiltration and the graft was finally lost. Immunohistological staining and immunoglobulin gene rearrangement studies to estimate the clonality of inflammatory cells revealed that the infiltrating plasma cells were polyclonal in origin. Epstein-Barr virus was not detected by in situ hybridization. From these results, we excluded the possibility of post-transplant lymphoproliferative disorder (PTLD); however, a precise definition and differential diagnosis between PCAR and PTLD has not yet been fully determined. As therapeutic regimens for PCAR and PTLD are different, definite guidelines for diagnosis and treatments of PCAR need to be established.
authors.affiliation: Molecular Pathology, Biomolecular and Integrated Medical Sciences, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Ibaraki, Japan.
authors.forename: Taisei
authors.initials: T
authors.lastname: Suzuki
authors.forename: Junya
authors.initials: J
authors.lastname: Fukuzawa
authors.forename: Shuichiroh
authors.initials: S
authors.lastname: Furuya
authors.forename: Kenji
authors.initials: K
authors.lastname: Yuzawa
authors.forename: Kumi
authors.initials: K
authors.lastname: Aita
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Ohkohchi
authors.forename: Michio
authors.initials: M
authors.lastname: Nagata
mesh_terms: D000208:Acute Disease; D002102:Cadaver; D006084:Graft Rejection / Q000175:diagnosis* / Q000209:etiology*; D006801:Humans; D016030:Kidney Transplantation / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D010950:Plasma Cells / Q000502:physiology*