Plasma Cell-Rich Rejection After Kidney Transplantation and the Role of Donor-Specific Antibodies: A Case Report and Review of the Literature

被引：8

作者：

Hasegawa, J. ^{[1
,4
]}

Honda, K. ^{[2
]}

Wakai, S. ^{[1
]}

Shirakawa, H. ^{[3
]}

Omoto, K. ^{[4
]}

Okumi, M. ^{[4
]}

Ishida, H. ^{[4
]}

Tanabe, K. ^{[4
]}

机构：

[1] Ohkubo Hosp, Dept Nephrol, Tokyo, Japan

[2] Tokyo Womens Med Univ, Dept Pathol, Tokyo 1628666, Japan

[3] Ohkubo Hosp, Dept Urol, Tokyo, Japan

[4] Tokyo Womens Med Univ, Dept Urol, Tokyo 1628666, Japan

来源：

TRANSPLANTATION PROCEEDINGS | 2015年 / 47卷 / 08期

关键词：

RENAL-ALLOGRAFT; MEDIATED REJECTION; PATIENT; MORPHOLOGY; OUTCOMES; THERAPY;

D O I：

10.1016/j.transproceed.2015.09.018

中图分类号：

R392 [医学免疫学]; Q939.91 [免疫学];

学科分类号：

100102 ;

摘要：

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.

引用

页码：2533 / 2536

页数：4

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