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Persistent subclinical rejection associated with nodular B‐cell infiltrates in a renal transplant recipient
Author(s) -
Toki Daisuke,
Ishida Hideki,
Horita Shigeru,
Tokumoto Tadahiko,
Shimizu Tomokazu,
Iizuka Jyunpei,
Tunoyama Kuniko,
Masumoto Kentaro,
Shirakawa Hiroki,
Setoguchi Kiyoshi,
Iida Shoichi,
Tanabe Kazunari,
Yamaguchi Yutaka
Publication year - 2008
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/j.1399-0012.2008.00850.x
Subject(s) - medicine , transplantation , rituximab , tacrolimus , subclinical infection , methylprednisolone , renal function , kidney transplantation , urology , creatinine , gastroenterology , kidney , pathology , surgery , lymphoma
Recently, B‐cell infiltrates in acute rejection grafts have attracted interest as an indicator of refractory rejection. Here, we report a case of deceased donor renal transplantation in a Japanese recipient operated overseas in which the recipient suffered from persistent tubulointerstitial rejection episodes associated with B‐cell infiltrates. A 59‐yr‐old man with end‐stage renal disease caused by immunoglobulin A nephropathy underwent deceased donor renal transplantation overseas in December 2005. The initial post‐operative course was uneventful. The patient was referred to our hospital one month after transplantation. He maintained stable renal function throughout the follow‐up period. The maintenance immunosuppressive regimen consisted of tacrolimus, mycophenolate mofetil and methylprednisolone. His serum creatinine concentration remained around 1.0 mg/dL, with no evidence of proteinuria. However, a discrepancy was detected between the renal function and the pathological findings. The pathology showed subclinical tubulointerstitial rejection with nodular B‐cell infiltrates refractory to aggressive antirejection therapy. A steroid pulse and 15‐deoxyspergualin were ineffective and the patient developed interstitial fibrosis and tubular atrophy by one yr after the transplantation, with persistent tubulitis and B‐cell infiltrates. We treated the refractory rejection with B‐cell infiltrates with a single 200 mg/body dose of rituximab and obtained an improvement. The pathological findings after administering rituximab consisted of mild tubulitis classified as Banff borderline, and elimination of the nodular B‐cell infiltrates. At present, 20 months after renal transplantation, the patient continues to maintain stable renal function, with a good serum creatinine concentration (0.87 mg/dL).