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

Abstract

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.

Expanding the antibody-mediated component of plasma cell-rich acute rejection: A case series

“…Several original studies and case reports have elicited the clinicomorphologic features of PCAR along with therapeutic nuances in elaborate details. [ 3 4 5 6 7 8 9 ] It is known that PCAR is a combined cell-mediated and ABMR. In the last 20 months, we have observed seven allograft biopsies showing morphologic features of PCAR with positivity for C4d and DSA satisfying the Banff criteria for an additional component of ABMR.…”