Tasaki Masayuki, Saito Kazuhide, Nakagawa Yuki, Ikeda Masahiro, Imai Naofumi, Ito Yumi, Sudo Masanori, Ikezumi Yohei, Yamada Takeshi, Hasegawa Hiroya, Kobayashi Takashi, Miura Kohei, Narita Ichie, Takahashi Kota, Tomita Yoshihiko
Division of Urology, Department of Regenerative & Transplant Medicine, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan.
Division of Urology, Department of Regenerative & Transplant Medicine, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan.
Transplant Proc. 2019 Jul-Aug;51(6):1732-1738. doi: 10.1016/j.transproceed.2019.02.038. Epub 2019 Jul 10.
Plasma cell-rich acute rejection (PCAR) and antibody-mediated rejection (ABMR), for which a standard treatment has not yet been established, are associated with poor graft survival after kidney transplantation. Here, we report a case series of 3 Japanese patients diagnosed with PCAR accompanied by ABMR. Steroid pulse therapy and rabbit antithymocyte globulin, plasma exchange, intravenous immunoglobulin, and rituximab therapies were sequentially performed in the first case. A graft biopsy after each treatment showed that plasma cell infiltration persisted. Five months after the initiation of rejection therapy, the patient was subjected to bortezomib therapy, which led to the partial elimination of plasma cells from the graft. However, the graft function gradually deteriorated, and hemodialysis treatment was warranted. In the other 2 cases, the patients received the same combination of therapy including bortezomib within a short period. Graft biopsies performed subsequently showed a marked decrease in the number of infiltrated plasma cells, and stabilization of renal graft function was achieved in both cases. Bortezomib, which targets plasma cells, is a potent drug that eliminates infiltrated plasma cells from the graft in PCAR. Thus, in addition to conventional therapy comprising plasma exchange, intravenous immunoglobulin, and rituximab against ABMR, bortezomib may be necessary to administer without any delay to control PCAR.
富含浆细胞的急性排斥反应（PCAR）和抗体介导的排斥反应（ABMR），目前尚未确立标准治疗方案，与肾移植后移植物存活率低相关。在此，我们报告了3例被诊断为伴有ABMR的PCAR的日本患者病例系列。在第一例患者中依次进行了类固醇脉冲疗法、兔抗胸腺细胞球蛋白、血浆置换、静脉注射免疫球蛋白和利妥昔单抗治疗。每次治疗后的移植肾活检显示浆细胞浸润持续存在。在开始排斥反应治疗5个月后，该患者接受了硼替佐米治疗，这导致移植肾中浆细胞部分清除。然而，移植肾功能逐渐恶化，需要进行血液透析治疗。在另外2例患者中，患者在短时间内接受了包括硼替佐米在内的相同联合治疗。随后进行的移植肾活检显示浸润的浆细胞数量显著减少，2例患者均实现了移植肾功能的稳定。硼替佐米靶向浆细胞，是一种有效的药物，可在PCAR中从移植肾中清除浸润的浆细胞。因此，除了针对ABMR的包括血浆置换、静脉注射免疫球蛋白和利妥昔单抗的传统治疗外，可能需要立即给予硼替佐米以控制PCAR。
