title: Plasma cell infiltrates and renal allograft outcomes in indigenous and non-indigenous people of the Northern Territory of Australia.
abstract: BACKGROUND
  Plasma cell-rich rejection is a distinct histological phenomenon associated with poor renal allograft outcomes. Aboriginal and Torres Straight Islander (ATSI) transplant recipients have poorer allograft survival and higher rates of acute rejection. We sought to determine whether a higher incidence of plasma cell-rich infiltrates (PCIR) could account for poorer survival.
  
  
  METHODS
  Renal transplant biopsies performed in recipients from the Northern Territory of Australia between 1985 and 2007 were reviewed and correlated with outcome. Biopsies were designated PCIR positive when plasma cells constituted >10% of the interstitial infiltrate.
  
  
  RESULTS
  Four hundred and seventy-seven biopsies from 177 recipients (108 ATSI) were performed. Median graft survival was shorter for recipients with PCIR: 4.0 years (interquartile range 2.18-6.41) versus 5.4 years (2.0-9.99) (P = 0.013). ATSI recipients had higher rates of plasma cell-rich rejection (RR 1.76, 95% CI 1.43-2.17, P < 0.0001), which occurred earlier (251 vs 869 days, P = 0.03) compared with non-indigenous recipients. On multivariate analysis, PCIR did not independently influence allograft survival. There was a correlation between PCIR and panel reactive antibody peak >20% (RR 1.29, 95% CI 1.03-1.56, P = 0.025), ≥5 human leukocyte antigen mismatches (RR 1.91, 1.41-2.58, p < 0.0001), increasing post-transplant infection rate (>10 infections RR 5.11, 1.69-15.5, P = 0.004), and subsequent death from septicaemia (RR 1.6, 1.17-2.18, P = 0.003).
  
  
  CONCLUSIONS
  PCIR is associated with infection and markers of chronic immunological stimulation but does not independently contribute to inferior renal allograft outcomes, even in ATSI recipients.
authors.affiliation: Central Northern Adelaide Renal and Transplantation Services, Royal Adelaide Hospital, Australia. natasha.rogers@health.sa.gov.au
authors.forename: Natasha M
authors.initials: NM
authors.lastname: Rogers
authors.forename: Paul D
authors.initials: PD
authors.lastname: Lawton
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Jose
mesh_terms: D001315:Australia / Q000453:epidemiology; D001706:Biopsy; D015935:Complement C4b / Q000276:immunology; D005260:Female; D006084:Graft Rejection / Q000208:ethnology* / Q000276:immunology*; D006085:Graft Survival / Q000276:immunology; D006650:Histocompatibility Testing; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D016030:Kidney Transplantation / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010446:Peptide Fragments / Q000276:immunology; D010950:Plasma Cells / Q000276:immunology / Q000473:pathology*; D044382:Population Groups / Q000706:statistics & numerical data*; D012307:Risk Factors; D014184:Transplantation, Homologous
chemical_list: D010446:Peptide Fragments; D015935:Complement C4b; C032261:complement C4d