Plasma cell-rich rejection accompanied by acute antibody-mediated rejection in a patient with ABO-incompatible kidney transplantation.
We report a case of plasma cell-rich rejection accompanied by acute antibody-mediated rejection in a patient with ABO-incompatible kidney transplantation. A 33-year-old man was admitted for an episode biopsy; he had a serum creatinine (S-Cr) level of 5.7 mg/dL 1 year following primary kidney transplantation. Histological features included two distinct entities: (1) a focal, aggressive tubulointerstitial inflammatory cell (predominantly plasma cells) infiltration with moderate tubulitis; and (2) inflammatory cell infiltration (including neutrophils) in peritubular capillaries. Substantial laboratory examination showed that the patient had donor-specific antibodies for DQ4 and DQ6. Considering both the histological and laboratory findings, we diagnosed him with plasma cell-rich rejection accompanied by acute antibody-mediated rejection. We started 3 days of consecutive steroid pulse therapy three times every 2 weeks for the former and plasma exchange with intravenous immunoglobulin (IVIG) for the latter histological feature. One month after treatment, a second allograft biopsy showed excellent responses to treatment for plasma cell-rich rejection, but moderate, acute antibody-mediated rejection remained. Therefore, we added plasma exchange with IVIG again. After treatment, allograft function was stable, with an S-Cr level of 2.8 mg/dL. This case report demonstrates the difficulty of the diagnosis of, and treatment for, plasma cell-rich rejection accompanied by acute antibody-mediated rejection in a patient with ABO-incompatible kidney transplantation. We also include a review of the related literature.
Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan.
Maiko
M
Furuya
Izumi
I
Yamamoto
Akimitsu
A
Kobayashi
Yasuyuki
Y
Nakada
Naoki
N
Sugano
Yudo
Y
Tanno
Ichiro
I
Ohkido
Nobuo
N
Tsuboi
Hiroyasu
H
Yamamoto
Keitaro
K
Yokoyama
Takashi
T
Yokoo
D000017:ABO Blood-Group System / Q000276:immunology*; D000208:Acute Disease; D000328:Adult; D001787:Blood Group Incompatibility / Q000276:immunology / Q000473:pathology* / Q000628:therapy; D006084:Graft Rejection / Q000276:immunology / Q000473:pathology*; D006683:HLA-DQ Antigens / Q000276:immunology; D006801:Humans; D007518:Isoantibodies / Q000097:blood; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D010950:Plasma Cells / Q000276:immunology / Q000473:pathology*; D010951:Plasma Exchange
D000017:ABO Blood-Group System; D006683:HLA-DQ Antigens; D007518:Isoantibodies
acute antibody-mediated rejection; anti-DQ antibody; plasma cell-rich rejection