Plaza Lara Eva, Hernández García Elena, Ruiz Fuentes Maria Del Carmen, Caba Molina Mercedes, De Gracia Guindo Maria Del Carmen, Osuna Ortega Antonio
Nephrology Deparment, University Hospital Virgen de las Nieves, Granada, Spain.
Nephrology Deparment, University Hospital Virgen de las Nieves, Granada, Spain.
Transplant Proc. 2020 Mar;52(2):512-514. doi: 10.1016/j.transproceed.2019.12.015. Epub 2020 Feb 12.
Plasma cell-rich acute rejection (PCAR) is a rare type of allograft rejection in renal transplantation. It is characterized by the presence of mature plasma cells that compromise more than 10% of inflammatory cells infiltrating the renal graft. The pathogenesis of PCAR is unknown, appears late, and has been related mainly to insufficient immunosuppression or infections. The treatment is not clearly defined, and the graft survival is poor. Here, we report a case series of 3 Spanish patients diagnosed with PCAR accompanied by donor-specific antibodies (DSA) after kidney transplantation. Mean to diagnosis was 2-12 years post-transplantation, and they began with abrupt deterioration of renal function. All patients were women and had preceding viral infection. In addition, two of the three patients recognize a doubtful adherence to immunosuppression. About treatment, 2 of the 3 patients, because the biopsy of the renal graft showed signs suggestive of incipient antibody-mediated rejection (ABMR) (glomerulitis, capilaritis, transplant glomerulopathy), were started with corticosteroids, anti-thymoglobulin, plasmapheresis, and intravenous immunoglobulins. The last patient, who only showed PCAR at biopsy, was treated with corticosteroids and anti-thymoglobulin. After treatment, graft function improved in all of them, but one patient developed an ABMR and another required a dialysis program, all of which indicates the difficulty in management and treatment of PCAR.
富含浆细胞的急性排斥反应（PCAR）是肾移植中一种罕见的同种异体移植排斥反应类型。其特征是成熟浆细胞的存在，这些浆细胞占浸润肾移植组织的炎性细胞的10%以上。PCAR的发病机制尚不清楚，出现较晚，主要与免疫抑制不足或感染有关。治疗方法尚不明确，移植肾存活率较低。在此，我们报告一组3例西班牙患者的病例系列，这些患者在肾移植后被诊断为PCAR并伴有供体特异性抗体（DSA）。诊断的平均时间为移植后2至12年，患者均以肾功能突然恶化为起始表现。所有患者均为女性，且之前有病毒感染。此外，3例患者中有2例承认免疫抑制依从性存疑。关于治疗，3例患者中有2例，因为肾移植活检显示有提示早期抗体介导的排斥反应（ABMR）的迹象（肾小球炎、毛细血管炎、移植性肾小球病），开始使用皮质类固醇、抗胸腺细胞球蛋白、血浆置换和静脉注射免疫球蛋白进行治疗。最后1例患者在活检时仅显示PCAR，接受了皮质类固醇和抗胸腺细胞球蛋白治疗。治疗后，所有患者的移植肾功能均有改善，但1例患者发生了ABMR，另1例需要透析治疗，所有这些都表明PCAR的管理和治疗存在困难。
