title: Immunohistological study of a pediatric patient with plasma cell-rich acute rejection.
abstract: We report here the case of a girl who developed plasma cell-rich acute rejection (PCAR), a condition characterized by the presence of mature plasma cells infiltrating a renal allograft. The patient's creatinine level increased sharply to 4.3 mg/dL from 0.9 mg/dL at 19 months post-renal transplantation. She showed no response to methylprednisolone pulse therapy at a dose of 500 mg for three d but did show an immediate clinical and histopathological response to muromonab-CD3 (OKT3) administration. She had two episodes of PCAR recurrence and subsequently lost her graft. She had no evidences of antibody-mediated rejection including C4d deposition in peritubular capillaries and donor-specific antibodies during the entire follow-up period. To elucidate the pathogenesis of PCAR, immunohistological examination of infiltrating cells was performed. CD3-positive cells infiltration seemed to be associated with the CD138-positive cells infiltration, and the number of CD3-positive cells was increased preceding PCAR recurrence. Additionally, a rapid decrease in the number of CD138-positive cells and CD3-positive cells following the OKT3 administration was observed. This case suggests that T-cell mediated immune mechanisms might play a role in the development of PCAR.
authors: Department of Pediatric Nephrology, Tokyo Women's Medical University School of Medicine, Tokyo, Japan.
authors: Hiroko
authors: H
authors: Chikamoto
authors: Noriko
authors: N
authors: Sugawara
authors: Yuko
authors: Y
authors: Akioka
authors: Tomokazu
authors: T
authors: Shimizu
authors: Shigeru
authors: S
authors: Horita
authors: Kazuho
authors: K
authors: Honda
authors: Takahito
authors: T
authors: Moriyama
authors: Junki
authors: J
authors: Koike
authors: Yutaka
authors: Y
authors: Yamaguchi
authors: Motoshi
authors: M
authors: Hattori
mesh_terms: D000293:Adolescent; D001402:B-Lymphocytes / Q000276:immunology / Q000473:pathology; D005260:Female; D006084:Graft Rejection / Q000276:immunology* / Q000473:pathology*; D006801:Humans; D007124:Immunoenzyme Techniques; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000276:immunology* / Q000473:pathology*; D008264:Macrophages / Q000276:immunology / Q000473:pathology; D010950:Plasma Cells / Q000276:immunology* / Q000473:pathology*; D013601:T-Lymphocytes / Q000276:immunology / Q000473:pathology; D014184:Transplantation, Homologous
chemical_list: D007166:Immunosuppressive Agents