Hamada Aki Mafune, Yamamoto Izumi, Kawabe Mayuko, Katsumata Haruki, Yamakawa Takafumi, Katsuma Ai, Nakada Yasuyuki, Kobayashi Akimitsu, Koike Yusuke, Miki Jun, Yamada Hiroki, Kimura Takahiro, Tanno Yudo, Ohkido Ichiro, Tsuboi Nobuo, Yamamoto Hiroyasu, Yokoo Takashi
Division of Nephrology and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan.
Department of Urology, Jikei University School of Medicine, Tokyo, Japan.
Nephrology (Carlton). 2018 Jul;23 Suppl 2:22-26. doi: 10.1111/nep.13277.
Plasma cell-rich acute rejection (PCAR) is a rare type of acute rejection in renal transplantation. Despite aggressive immunotherapy, approximately 40-60% of patients develop graft loss within 1 year after an episode of PCAR. However, the reason for this outcome remains obscure. This study retrospectively identified six patients with PCAR diagnosed between 2009 and 2015 at a single university hospital. Clinicopathological data were collected. Five of the six patients were male, and mean age at the onset of PCAR was 49.0 ±14.5 years. None of the patients showed overall poor adherence to medication. Mean time to diagnosis was 302 ±234 days post-transplantation. All patients had preceding or concurrent viral infection. Four patients developed PCAR alone and two patients developed PCAR with antibody-mediated rejection. One of the six patients showed both severe tubulointerstitial and microvascular inflammation (total of Banff tubulitis 't' + interstitial inflammation 'i' + glomerulitis 'g' + peritubular capillaritis 'ptc' scores >10). This patient had progressive worsening of graft function and re-initiated dialysis at 74 months after a PCAR episode. In addition, three of the six patients had long-term recurrence of PCAR. With the recurrence of PCAR, patients with both moderate tubulointerstitial and microvascular inflammation (total of Banff 't' + 'i' + 'g' + 'ptc' scores >6) had progressive worsening of graft function. In summary, the present results suggest that concurrent moderate to severe tubulointerstitial and microvascular inflammation may lead to poor outcomes of graft function after a PCAR episode.
富含浆细胞的急性排斥反应（PCAR）是肾移植中一种罕见的急性排斥反应类型。尽管采取了积极的免疫治疗，但约40%-60%的患者在发生一次PCAR后1年内出现移植肾失功。然而，这一结果的原因仍不清楚。本研究回顾性分析了2009年至2015年在一家大学医院确诊的6例PCAR患者。收集了临床病理数据。6例患者中有5例为男性，PCAR发病时的平均年龄为49.0±14.5岁。所有患者均未表现出总体上对药物治疗的依从性差。诊断的平均时间为移植后302±234天。所有患者均有先前或同时发生的病毒感染。4例患者单独发生PCAR，2例患者发生PCAR合并抗体介导的排斥反应。6例患者中有1例表现出严重的肾小管间质和微血管炎症（Banff肾小管炎“t”+间质炎症“i”+肾小球炎“g”+肾小管周围毛细血管炎“ptc”评分总和>10）。该患者在PCAR发作后74个月移植肾功能逐渐恶化并重新开始透析。此外，6例患者中有3例出现PCAR长期复发。随着PCAR的复发，伴有中度肾小管间质和微血管炎症（Banff“t”+“i”+“g”+“ptc”评分总和>6）的患者移植肾功能逐渐恶化。总之，目前的结果表明，PCAR发作后并发中度至重度肾小管间质和微血管炎症可能导致移植肾功能不良。
