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Subclinical antibody‐mediated rejection due to anti‐human‐leukocyte‐antigen‐DR53 antibody accompanied by plasma cell‐rich acute rejection in a patient with cadaveric kidney transplantation
Author(s) -
Katsuma Ai,
Yamamoto Izumi,
Komatsuzaki Yo,
Niikura Takahito,
Kawabe Mayuko,
Okabayashi Yusuke,
Yamakawa Takafumi,
Katsumata Haruki,
Nakada Yasuyuki,
Kobayashi Akimitsu,
Tanno Yudo,
Miki Jun,
Yamada Hiroki,
Ohkido Ichiro,
Tsuboi Nobuo,
Yamamoto Hiroyasu,
Yokoo Takashi
Publication year - 2016
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.12772
Subject(s) - medicine , subclinical infection , plasma cell , rituximab , biopsy , pathology , antibody , transplantation , kidney , kidney transplantation , antigen , nephrology , immunology , gastroenterology
A 56‐year‐old man who had undergone cadaveric kidney transplantation 21 months earlier was admitted to our hospital for a protocol biopsy; he had a serum creatinine level of 1.2 mg/dL and no proteinuria. Histological features showed two distinct entities: (i) inflammatory cell infiltration, in the glomerular and peritubular capillaries and (ii) focal, aggressive tubulointerstitial inflammatory cell infiltration, predominantly plasma cells, with mild tubulitis (Banff 13 classification: i2, t1, g2, ptc2, v0, ci1, ct1, cg0, cv0). Immunohistological studies showed mildly positive C4d immunoreactivity in the peritubular capillaries. The patient had donor specific antibody to human‐leucocyte‐antigen‐DR53. We diagnosed him with subclinical antibody‐mediated rejection accompanied by plasma cell‐rich acute rejection. Both antibody‐mediated rejection due to anti‐ human‐leucocyte‐antigen ‐DR53 antibodies and plasma cell‐rich acute rejection are known to be refractory and have a poor prognosis. Thus, we started plasma exchange with intravenous immunoglobulin and rituximab for the former and 3 days of consecutive steroid pulse therapy for the latter. Three months after treatment, a follow‐up allograft biopsy showed excellent responses to treatment for both histological features. This case report considers the importance of an early diagnosis and appropriate intervention for subclinical antibody‐mediated rejection due to donor specific antibody to human‐leucocyte‐antigen‐DR53 and plasma cell‐rich acute rejection.