title: Plasma cell-rich acute rejections in living-related kidney transplantation: a clinicopathological study of 50 cases.
abstract: BACKGROUND
  Acute rejections (ARs) with plasma cell-rich infiltrates (PCARs) are associated with poor outcomes.
  
  
  METHODS
  Between February 2012 and December 2013, 1630 dysfunctional renal graft biopsies were performed. Of these, 50 (3%) showed PCAR. ARs with >10% plasma cells were defined as PCAR. Human leukocyte antigen (HLA) antibodies were tested in historic sera and at the time of PCAR. Treatment for PCAR comprised methylprednisolone, antithymocyte globulin, plasmapheresis, and anti-CD20 antibody.
  
  
  RESULTS
  Of the 1630 dysfunctional biopsies, 50 (3%) had PCAR which occurred 3.1 ± 2.55 yr after transplant. The percentage of plasma cells was 28.8 ± 11.7, and CD138, 29.0 ± 12.4. Donor-specific antibodies (DSAs) were found in 32 (64%) overall, Class I in 15% and Class II in 65%. Post-treatment serum creatinine improved from 3.80 ± 2.59 to 2.66 ± 1.59 mg/dL in DSA positive (p < 0.003) and from 2.59 ± 1.09 to 2.08 ± 0.86 mg/dL in DSA negative (p < 0.008). One- and two-yr graft survival after PCAR was 72%, 42% in the DSA-positive vs. 89%, 82% in the DSA-negative group, respectively (p = 0.071).
  
  
  CONCLUSIONS
  Our results show that PCAR occurs late after transplant and in many cases is associated with DSAs. Graft outcome was poor when PCAR was associated with DSAs.
authors.affiliation: Department of Pathology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan.
authors.forename: Khawar
authors.initials: K
authors.lastname: Abbas
authors.affiliation: Department of Pathology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan.
authors.forename: Muhammed
authors.initials: M
authors.lastname: Mubarak
authors.affiliation: Department of Pathology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan.
authors.forename: Mirza N
authors.initials: MN
authors.lastname: Zafar
authors.affiliation: Department of Nephrology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan.
authors.forename: Tahir
authors.initials: T
authors.lastname: Aziz
authors.affiliation: Department of Nephrology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan.
authors.forename: Haider
authors.initials: H
authors.lastname: Abbas
authors.affiliation: Department of Pathology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan.
authors.forename: Rana
authors.initials: R
authors.lastname: Muzaffar
authors.affiliation: Department of Urology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan.
authors.forename: Syed A H
authors.initials: SA
authors.lastname: Rizvi
mesh_terms: D000293:Adolescent; D000328:Adult; D001706:Biopsy; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000276:immunology* / Q000473:pathology; D006085:Graft Survival; D006801:Humans; D007668:Kidney / Q000276:immunology* / Q000473:pathology; D016030:Kidney Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010950:Plasma Cells / Q000276:immunology*; D012189:Retrospective Studies; D055815:Young Adult
keywords: acute rejection; graft outcome; kidney transplant; living related; plasma cell-rich infiltrates