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Plasma cell‐rich acute rejections in living‐related kidney transplantation: a clinicopathological study of 50 cases
Author(s) -
Abbas Khawar,
Mubarak Muhammed,
Zafar Mirza N.,
Aziz Tahir,
Abbas Haider,
Muzaffar Rana,
Rizvi Syed A. H.
Publication year - 2015
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.12589
Subject(s) - medicine , plasmapheresis , dysfunctional family , antibody , transplantation , gastroenterology , creatinine , immunology , psychiatry
Background Acute rejections ( AR s) with plasma cell‐rich infiltrates ( PCAR s) are associated with poor outcomes. Patients and methods Between F ebruary 2012 and D ecember 2013, 1630 dysfunctional renal graft biopsies were performed. Of these, 50 (3%) showed PCAR . AR s 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‐ CD 20 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 CD 138, 29.0 ± 12.4. Donor‐specific antibodies ( DSA s) 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 DSA s. Graft outcome was poor when PCAR was associated with DSA s.