Department of Nephrology, Army Hospital (Research and Referral), New Delhi, India.
Department of Pathology, Army Hospital (Research and Referral), New Delhi, India.
Saudi J Kidney Dis Transpl. 2021 Mar-Apr;32(2):387-397. doi: 10.4103/1319-2442.335451.
Plasma cell-rich rejection is a rare and poorly defined entity. Its treatment is not clearly defined and has universally poor prognosis. More data should be published from various transplant centers around the world to identify the treatment that has the best outcomes and to formulate treatment guidelines for these cases. It is a retrospective analysis of kidney biopsies form 2008 to 2018. Four hundred biopsied were screened and 55 were found to have features of rejection and among them, 13 had plasma cell-rich rejection. Data of treatment given and the graft survival outcomes in these cases were retrieved by medical records. One patient had complete recovery, three had graft loss and the remaining nine had permanent decline in glomerular filtration rate. Decrease in immunosuppression and presence of infection are risk factors for plasma cell-rich acute rejection (PCAR). It can be acute cell-mediated rejection (ACR)/antibody-mediated rejection (AMR)/ACR+AMR. Resistant rejection, ACR+AMR, C4d positivity, and severe interstitial inflammation are poor prognostic factors. Overzealous decrease in immunosuppression should not be done. Management of immunosuppression during infection is most critical for the development of PCAR. Bortezomib is emerging as a therapeutic modality for the treatment of PCAR.
富含浆细胞的排斥反应是一种罕见且定义不明确的实体。其治疗方法尚未明确，预后普遍较差。应从世界各地的各个移植中心发布更多数据，以确定哪种治疗方法具有最佳效果，并为这些病例制定治疗指南。这是对 2008 年至 2018 年的肾活检进行的回顾性分析。筛选了 400 份活检，发现其中 55 份有排斥反应特征，其中 13 份为富含浆细胞的排斥反应。通过病历检索了这些病例中给予的治疗数据和移植物的生存结果。1 例患者完全恢复，3 例患者移植物丢失，其余 9 例患者肾小球滤过率永久性下降。免疫抑制的减少和感染的存在是富含浆细胞的急性排斥反应（PCAR）的危险因素。它可以是急性细胞介导的排斥反应（ACR）/抗体介导的排斥反应（AMR）/ACR+AMR。难治性排斥反应、ACR+AMR、C4d 阳性和严重的间质炎症是预后不良的因素。不应该过度减少免疫抑制。感染期间免疫抑制的管理对于 PCAR 的发展至关重要。硼替佐米作为治疗 PCAR 的治疗方法正在出现。
