A case of plasma cell‐rich acute rejection 18 months after kidney transplantation successfully treated with steroid pulse therapy

Shimizu, Tomokazu; Ishida, Hideyuki; Shirakawa, Hiroki; Omoto, Kazuya; Tanabe, Kazunari; Yamaguchi, Yutaka

doi:10.1111/j.1399-0012.2008.00851.x

Cited by 3 publications

(2 citation statements)

References 9 publications

(30 reference statements)

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“…By contrast, ABMR is often resistant to steroid therapy alone, and multiple antirejection therapies have been recommended for ABMR, including IVIG, rituximab, and plasma exchange [15]. Furthermore, a previous report demonstrated steroid sensitivity in a PCAR case negative for C4d immunostaining in peritubular capillaries and without DSAs, as in our case [7]. Moreover, Abbas et al showed a strong effect of DSAs in PCAR leading to allograft loss ( p = 0.001 by log-rank test) [13].…”

Section: Discussionsupporting

confidence: 50%

Successful Treatment of Plasma Cell-Rich Acute Rejection Using Pulse Steroid Therapy Alone: A Case Report

Komatsuzaki

Nakada

Yamamoto

et al. 2017

Case Reports in Transplantation

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Despite the recent development of immunosuppressive agents, plasma cell-rich acute rejection (PCAR) has remained refractory to treatment. Herein, we report an unusual case of PCAR that responded well to pulse steroid therapy alone. A 47-year-old man was admitted for a protocol biopsy three months after kidney transplantation, with a stable serum creatinine level of 1.6 mg/dL. Histological examination showed focal aggressive tubulointerstitial inflammatory cell infiltration of predominantly polyclonal mature plasma cells, leading to our diagnosis of PCAR. Three months following three consecutive days of high-dose methylprednisolone (mPSL) therapy, an allograft biopsy performed for therapy evaluation showed persistent PCAR. We readministered mPSL therapy and successfully resolved the PCAR. Although PCAR generally develops more than six months after transplantation, we diagnosed this case early, at three months after transplantation, with focally infiltrated PCAR. This case demonstrates the importance of early diagnosis and prompt treatment of PCAR to manage the development and severity of allograft rejection.

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Section: Discussionsupporting

confidence: 50%

Successful Treatment of Plasma Cell-Rich Acute Rejection Using Pulse Steroid Therapy Alone: A Case Report

Komatsuzaki

Nakada

Yamamoto

et al. 2017

Case Reports in Transplantation

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“…Shimizu et al. (13) have also reported that treatment with steroid pulse therapy alone could resolve PCAR.…”

Section: Discussionmentioning

confidence: 97%

Plasma cell‐rich acute rejection after renal transplantation in a patient with pyoderma gangrenosum: a case report

Horie¹,

Fujita²,

Tsuyuki³

et al. 2010

Clinical Transplantation

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Horie K, Fujita T, Tsuyuki M, Nishio F, Watanabe T, Kanou Y, Kuzuya A, Sato M, Kinukawa T. Plasma cell‐rich acute rejection after renal transplantation in a patient with pyoderma gangrenosum: a case report. Clin Transplant 2010: 24 (Suppl. 22): 39–43. © 2010 John Wiley & Sons A/S. Abstract: A 40‐yr‐old female received a living‐related renal transplantation on January 29, 2008. She had type I diabetes mellitus and pyoderma gangrenosum (PG). Induction immunosuppressive therapy consisted of tacrolimus, mycophenolate mofetil, basiliximab, and prednisolone. Intravenous methylprednisolone pulse therapy was administered to prevent ulceration at the surgical site. The postoperative outcome was almost uneventful, and renal graft function was well preserved for 11 months. Her graft function deteriorated on December 24, 2008 and thus an episode biopsy was performed. The histopathological findings were consistent with plasma cell‐rich acute rejection (PCAR). During hospitalization, it was noted that the patient was non‐compliant. We then performed steroid pulse therapy, and her graft function and histological findings improved. This is the first report of PCAR in a patient with PG who received a renal allograft. It was thought that PCAR was triggered because of her non‐compliance. Thus, we should recognize the importance of enhancing compliance in transplant recipients.

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Plasma Cell–Rich Rejection After Kidney Transplantation and the Role of Donor-Specific Antibodies: A Case Report and Review of the Literature

Hasegawa

Honda

Wakai

et al. 2015

Transplantation Proceedings

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A case of plasma cell‐rich acute rejection 18 months after kidney transplantation successfully treated with steroid pulse therapy

Cited by 3 publications

References 9 publications

Successful Treatment of Plasma Cell-Rich Acute Rejection Using Pulse Steroid Therapy Alone: A Case Report

Successful Treatment of Plasma Cell-Rich Acute Rejection Using Pulse Steroid Therapy Alone: A Case Report

Plasma cell‐rich acute rejection after renal transplantation in a patient with pyoderma gangrenosum: a case report

Plasma Cell–Rich Rejection After Kidney Transplantation and the Role of Donor-Specific Antibodies: A Case Report and Review of the Literature

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