The clinical and pathologic implications of plasmacytic infiltrates in percutaneous renal allograft biopsies

Meehan, Shane M.; Domer, Peter H.; Ma, Jianchao; Donoghue, M.; Sadhu, A.; Ho, Lam T.; Aronson, Andrew J.; Thistlethwaite, J. Richard; Haas, Martin

doi:10.1053/hupa.2001.21574

Cited by 84 publications

(92 citation statements)

References 21 publications

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“…38 Whether an antibody-mediated component in acute rejection could have an additional detrimental effect on patients with herpesvirus infections needs to be further investigated. In agreement with a study showing the association of CMV infection with the development of acute rejections 9 and with studies concerning acute rejections with a high number of plasma cells, 47,51 we did not find evidence of CMV or EBV virus in the renal biopsies. This suggests that the viruses could have influenced the histology of the rejection in an indirect manner.…”

Section: Discussionsupporting

confidence: 92%

Acute rejection and graft survival in renal transplanted patients with viral diseases

et al. 2004

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Transplanted patients are susceptible to viral infections; thus, the aim of this study was to evaluate the features of acute rejections and the outcome of the renal graft in transplanted patients with herpes virus diseases. Renal biopsies from 30 renal transplanted patients undergoing early acute rejection (type IA and IB according to the Banff 97 classification) were evaluated. In total, 15 of these patients experienced cytomegalovirus (CMV) or Epstein-Barr virus disease within the first year following transplantation (group I) and 15 patients showed no evidence of viral infection (group II). No significant differences between the groups in terms of age, male/female ratio, living/cadaveric donor ratio, cold ischemia time, HLA A-B matching, pretransplant panel reactive antibody test, occurrence of post-transplant tubular necrosis, plasma levels of cyclosporin A and mean percent increase of serum creatinine at the time of the biopsy were observed. In group I biopsies, the mean number of interstitial plasma cells, as well as the mean number of CD79a-positive cells (B lymphocytes and plasma cells) was significantly higher than in group II (Po0.01 and o0.01, respectively). There was a positive correlation between the number of infections and the number of plasma cells (Po0.05). In transplanted patients, CMV can trigger the formation of anti-endothelial cell antibodies, which have been proposed to play a role in antibody-mediated rejections. We investigated whether a deposition of C4d, a marker of antibody-mediated reactions, was present in renal peritubular capillaries. In group I C4d deposition was found in five cases, while in group II it was not observed (Po0.05). In group I, 7/15 patients developed chronic allograft nephropathy vs 1/15 patients in group II (Po0.05). The estimated 1-, 5-and 8-year cumulative graft survival rates were 80, 66 and 57%, respectively, in group I, while in group II the estimated 8-year cumulative survival rate was 100% (Po0.05). In conclusion, acute rejection biopsies of patients with viral infections displayed plasma cell infiltrates and, in several cases, C4d deposition. Our study suggests a role of B lymphocytes in the pathology of these rejections and confirms the association between viral infections and poor graft survival.

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Section: Discussionsupporting

confidence: 92%

Acute rejection and graft survival in renal transplanted patients with viral diseases

et al. 2004

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“…Additional antibodies may be required in specific circumstances, for example, amyloid speciation, 16,17 collagen IV alpha chains in hereditary nephritis, 18,19 IgG subclasses, 20,21 virus identification, [22][23][24][25] lymphocyte phenotyping in allografts in suspected cases of PTLD, 26,27 C4d in allograft biopsies, 28,29 etc. In the absence of appropriate tissue in the IF sample, paraffin-embedded material can be examined using IP techniques (see later).…”

Section: Stainingmentioning

confidence: 99%

Practice guidelines for the renal biopsy

2004

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“…1 Plasma cell infiltration also is observed in renal allograft biopsies from patients with PTLDs such as plasmacytic hyperplasia, polymorphous B-cell hyperplasia, or plasmacytomalike PTLD. 2 An association between plasmacytic infiltration into renal allografts and PTLD has been reported in a few studies. 2 As with PCAR, PTLD confined to the renal allograft has a poor clinical outcome.…”

Section: Introductionmentioning

confidence: 97%

“…2 An association between plasmacytic infiltration into renal allografts and PTLD has been reported in a few studies. 2 As with PCAR, PTLD confined to the renal allograft has a poor clinical outcome. All reported cases of PTLD confined to a renal allograft have undergone a transplant nephrectomy because of acute rejection during reduction of immunosuppression.…”

Section: Introductionmentioning

confidence: 97%

“…In PCAR, which is observed in 5% patients with biopsy-proven acute rejection, mature plasma cells comprise > 10% inflammatory cells in the graft 1,2 ; this syndrome often is observed in patients noncompliant with immunosuppressive therapy 3 and is associated with a poor outcome irrespective of the Banff score. The reason for the poor outcome of PCAR is unknown but might be related to the humoral component in graft injuries.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Plasma Cell-Rich Acute Rejection With Monoclonal Gammopathy in a Renal Transplant Recipient

Sun

Cho²,

Hong³

et al. 2013

Exp Clin Transplant

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Plasma cell infiltration into a renal allograft comprises a spectrum of lesions from acute rejection to posttransplant lymphoproliferative disease. We report an unusual case of plasma cell infiltration into a renal allograft with monoclonal gammopathy. A 42-year-old woman was admitted because of graft dysfunction after noncompliance with immunosuppressive therapy for 5 months. A graft biopsy showed acute T-cell-mediated rejection and massive plasma cell infiltration. Despite initial treatment with steroids and antithymocyte globulin, there was persistence of graft dysfunction, monoclonal gammopathy, and plasma cell infiltration. Subsequent treatment with bortezomib improved graft function and caused the monoclonal gammopathy to resolve. Immunohistochemical evaluation of markers of B cells (CD20 and CD138) and the ratio of kappa-to-lambda light chain (15:1) showed that infiltrating cells were plasma cells producing kappa light chain. This suggested that plasma cell-rich acute rejection with monoclonal gammopathy in this patient might have been in an early stage of kappa light chain-producing posttransplant lymphoproliferative disease confined to the renal allograft, and that bortezomib may be effective in treating a patient with this condition.

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The clinical and pathologic implications of plasmacytic infiltrates in percutaneous renal allograft biopsies

Cited by 84 publications

References 21 publications

Acute rejection and graft survival in renal transplanted patients with viral diseases

Acute rejection and graft survival in renal transplanted patients with viral diseases

Practice guidelines for the renal biopsy

Plasma Cell-Rich Acute Rejection With Monoclonal Gammopathy in a Renal Transplant Recipient

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