title: Plasma Cell-Rich Rejection After Kidney Transplantation and the Role of Donor-Specific Antibodies: A Case Report and Review of the Literature.
abstract: OBJECTIVE
  We report a case of the clinical course and pathologic findings for a kidney transplant recipient with plasma cell-rich rejection (PCRR) accompanied by antibody-mediated rejection (ABMR).
  
  
  METHODS
  A 29-year-old man with end-stage renal disease caused by lupus nephritis received an ABO-compatible living kidney transplant.
  
  
  RESULTS
  Eighteen months after transplantation, the patient presented with proteinuria and increased serum creatinine. An episode biopsy revealed severe tubulointerstitial infiltration with plasma cells accompanied by peritubular capillaritis and positive findings on immunofluorescent C4d staining. Donor-specific antibodies were positive for DR52, and the patient was subsequently diagnosed with PCRR accompanied by ABMR. Treatment was initiated with high-dose steroids, intravenous immunoglobulin, gusperimus hydrochloride, muronmonab antibody CD3, and rituximab. However, ABMR persisted and allograft failure developed 20 months after onset.
  
  
  CONCLUSIONS
  We argue that PCRR accompanied by ABMR is a subtype of PCRR that can progress to allograft failure owing to persistent ABMR.
authors.affiliation: Department of Nephrology, Ohkubo Hospital, Tokyo, Japan; Department of Urology, Tokyo Women's Medical University, Tokyo, Japan.
authors.forename: J
authors.initials: J
authors.lastname: Hasegawa
authors.affiliation: Department of Pathology, Tokyo Women's Medical University, Tokyo, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Honda
authors.affiliation: Department of Nephrology, Ohkubo Hospital, Tokyo, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Wakai
authors.affiliation: Department of Urology, Ohkubo Hospital, Tokyo, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Shirakawa
authors.affiliation: Department of Urology, Tokyo Women's Medical University, Tokyo, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Omoto
authors.affiliation: Department of Urology, Tokyo Women's Medical University, Tokyo, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Okumi
authors.affiliation: Department of Urology, Tokyo Women's Medical University, Tokyo, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Ishida
authors.affiliation: Department of Urology, Tokyo Women's Medical University, Tokyo, Japan. Electronic address: tanabe@kc.twmu.ac.jp.
authors.forename: K
authors.initials: K
authors.lastname: Tanabe
mesh_terms: D000017:ABO Blood-Group System; D000328:Adult; D000918:Antibody Specificity; D001706:Biopsy; D006084:Graft Rejection / Q000276:immunology*; D059810:HLA-DR Serological Subtypes / Q000276:immunology; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007518:Isoantibodies / Q000032:analysis / Q000276:immunology*; D007668:Kidney / Q000276:immunology; D007676:Kidney Failure, Chronic / Q000601:surgery*; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000379:methods; D019520:Living Donors; D008181:Lupus Nephritis / Q000150:complications; D008297:Male; D010950:Plasma Cells / Q000276:immunology*; D066027:Transplant Recipients; D014184:Transplantation, Homologous
chemical_list: D000017:ABO Blood-Group System; D059810:HLA-DR Serological Subtypes; C051104:HLA-DR52 antigen; D016756:Immunoglobulins, Intravenous; D007518:Isoantibodies