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Plasma cell‐rich rejection accompanied by acute antibody‐mediated rejection in a patient with ABO ‐incompatible kidney transplantation
Author(s) -
Furuya Maiko,
Yamamoto Izumi,
Kobayashi Akimitsu,
Nakada Yasuyuki,
Sugano Naoki,
Tanno Yudo,
Ohkido Ichiro,
Tsuboi Nobuo,
Yamamoto Hiroyasu,
Yokoyama Keitaro,
Yokoo Takashi
Publication year - 2014
Publication title -
nephrology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.752
H-Index - 61
eISSN - 1440-1797
pISSN - 1320-5358
DOI - 10.1111/nep.12245
Subject(s) - abo blood group system , medicine , kidney transplantation , antibody , transplantation , immunology , donor specific antibodies , graft rejection , kidney , isoantibodies
We report a case of plasma cell‐rich rejection accompanied by acute antibody‐mediated rejection in a patient with ABO ‐incompatible kidney transplantation. A 33‐year‐old man was admitted for an episode biopsy; he had a serum creatinine ( S ‐ C r) level of 5.7 mg/dL 1 year following primary kidney transplantation. Histological features included two distinct entities: (1) a focal, aggressive tubulointerstitial inflammatory cell (predominantly plasma cells) infiltration with moderate tubulitis; and (2) inflammatory cell infiltration (including neutrophils) in peritubular capillaries. Substantial laboratory examination showed that the patient had donor‐specific antibodies for DQ 4 and DQ 6. Considering both the histological and laboratory findings, we diagnosed him with plasma cell‐rich rejection accompanied by acute antibody‐mediated rejection. We started 3 days of consecutive steroid pulse therapy three times every 2 weeks for the former and plasma exchange with intravenous immunoglobulin ( IVIG ) for the latter histological feature. One month after treatment, a second allograft biopsy showed excellent responses to treatment for plasma cell‐rich rejection, but moderate, acute antibody‐mediated rejection remained. Therefore, we added plasma exchange with IVIG again. After treatment, allograft function was stable, with an S ‐ C r level of 2.8 mg/dL. This case report demonstrates the difficulty of the diagnosis of, and treatment for, plasma cell‐rich rejection accompanied by acute antibody‐mediated rejection in a patient with ABO ‐incompatible kidney transplantation. We also include a review of the related literature.