Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
Medicine (Baltimore). 2022 Sep 9;101(36):e30493. doi: 10.1097/MD.0000000000030493.
Plasma cell-rich acute rejection (PCAR), a subtype of T cell-mediated rejection, is a relatively rare type of acute allograft rejection, that is usually associated with a higher rate of graft failure. However, it is difficult to diagnose PCAR precisely.
A 45-year-old woman who had received a kidney transplant presented with acute kidney injury and uremic symptoms approximately 1 year after transplantation.
A renal biopsy was performed and pathological examination revealed marked inflammation with abundant plasma cells in areas within interstitial fibrosis and tubular atrophy. The patient was diagnosed with PCAR and chronic active T cell-mediated rejection (CA-TCMR) grade IA.
Immunosuppressants were administered as tacrolimus (2 mg twice daily), mycophenolate mofetil (250 mg twice daily), and prednisolone (15 mg/day) for suspected PCAR.
The patients showed rapid deterioration in kidney function and reached impending graft failure.
PCAR is often associated with poor graft outcome. The high variability in tacrolimus levels could contribute to poor patient outcomes, leaving aggressive immunosuppressive therapy as the remaining choice for PCAR treatment.
浆细胞丰富性急性排斥反应（PCAR）是 T 细胞介导的排斥反应的一种亚型，是一种相对罕见的急性移植物排斥反应，通常与更高的移植物失功率相关。然而，PCAR 的精确诊断具有一定难度。
一名 45 岁女性，肾移植术后 1 年余，因急性肾损伤和尿毒症症状就诊。
进行了肾活检，病理检查显示间质纤维化和肾小管萎缩区域有明显炎症，富含浆细胞。患者被诊断为 PCAR 和慢性活动性 T 细胞介导的排斥反应（CA-TCMR）IA 级。
怀疑为 PCAR，给予免疫抑制剂治疗，包括他克莫司（2mg，每日 2 次）、霉酚酸酯（250mg，每日 2 次）和泼尼松（15mg/d）。
患者肾功能迅速恶化，接近移植物失功。
PCAR 常与移植物预后不良相关。他克莫司水平的高度变异性可能导致患者预后不良，对于 PCAR 治疗，积极的免疫抑制治疗仍是唯一选择。
