Hasegawa J, Honda K, Wakai S, Shirakawa H, Omoto K, Okumi M, Ishida H, Tanabe K
Department of Nephrology, Ohkubo Hospital, Tokyo, Japan; Department of Urology, Tokyo Women's Medical University, Tokyo, Japan.
Department of Pathology, Tokyo Women's Medical University, Tokyo, Japan.
Transplant Proc. 2015 Oct;47(8):2533-6. doi: 10.1016/j.transproceed.2015.09.018.
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).
A 29-year-old man with end-stage renal disease caused by lupus nephritis received an ABO-compatible living kidney transplant.
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.
We argue that PCRR accompanied by ABMR is a subtype of PCRR that can progress to allograft failure owing to persistent ABMR.
我们报告一例肾移植受者的临床病程及病理结果，该患者患有富含浆细胞性排斥反应（PCRR）并伴有抗体介导的排斥反应（ABMR）。
一名29岁因狼疮性肾炎导致终末期肾病的男性接受了ABO血型相容的活体肾移植。
移植后18个月，患者出现蛋白尿和血清肌酐升高。一次穿刺活检显示严重的肾小管间质浆细胞浸润，伴有肾小管周围毛细血管炎，免疫荧光C4d染色呈阳性。供者特异性抗体DR52呈阳性，该患者随后被诊断为伴有ABMR的PCRR。开始使用大剂量类固醇、静脉注射免疫球蛋白、盐酸胍立莫司、鼠单克隆抗体CD3和利妥昔单抗进行治疗。然而，ABMR持续存在，发病20个月后出现移植肾失功。
我们认为伴有ABMR的PCRR是PCRR的一种亚型，由于持续性ABMR可进展为移植肾失功。
