Abstract: SA-PO947

Long-Term Outcome after Treatment of Plasma Cell-Rich Rejection of the Kidney in Simultaneous Kidney and Pancreas and Kidney and Liver Transplant Recipients

Session Information

Category: Nephrology Education

  • 1302 Fellows and Residents Case Reports

Authors

  • Vucur, Ksenija, University of Zagreb School of Medicine and University Hospital Merkur, Zagreb, Croatia
  • Jurekovic, Zeljka, University of Zagreb School of Medicine and University Hospital Merkur, Zagreb, Croatia
  • Cingel, Branislav, University of Zagreb School of Medicine and University Hospital Merkur, Zagreb, Croatia
  • Ljubanovic, Danica Galesic, University of Zagreb School of Medicine, Clinical Hospital Dubrava, Zagreb, Croatia
  • Knotek, Mladen, University of Zagreb School of Medicine and University Hospital Merkur, Zagreb, Croatia
Background

Although plasma cells (PC) participate in the kidney graft rejection, their major involvement (i.e. plasma cell rich rejection - PCRR) is rare. We identified three cases with PCRR among simultaneous kidney-pancreas (SPKT) and liver-kidney (SLKT) recipients in our center.

Methods

Case I: A 35-yr old Caucasian male who had SPKT in 2006 presented three mths posttx with renal dysfunction. Kidney biopsy (bx) showed acute cellular rejection (ACR) IB with infiltrate consisting of 17% of PC. Donor-specific antibodies (DSA) were negative. After treatment with steroid boluses there was only a mild decrease in serum creatinine, and the second bx revealed again PCAR. Treatment with high-dose (2 g/kg) IVIG and boluses of steroids led to normalization of renal function. On a follow-up bx at 1 yr, there were no signs of rejection. Eleven yrs later, both graft function is excellent.
Case II: A 55-yr old Caucasian male who received SLKT in 2006 presented two yrs after tx with renal dysfunction. Kidney bx revealed ACR IB. The infiltrate consisted of 27% PC. After treatment with high-dose IVIG and steroid boluses, a repeat bx showed no signs of acute rejection. Subsequently, the patient had persistent stable renal dysfunction. He died in 2012 from sepsis.
Case III: A 36-yr old Caucasian male presented in 2009, four yrs after SPKT with worsening of renal function. Kidney bx revealed acute PCRR with microvascular injury (MVI) that was treated with steroid boluses. At that time he had DSA against DQ and DR. Subsequent two bx showed persistent ACR and the treatment included high-dose IVIG. Afterwards renal function improved, but five yrs later serum creatinine increased again, and on biopsy PCRR with MVI was again diagnosed. It was treated with bolus of steroids and high-dose IVIG and was followed by creatinine decrease. On the last visit in 2017 patient had both graft function stable with creatinine 155 µmol/L.

Conclusion

We showed that in SPKT or SLKT PCRR may affect only kidney function and was only partially associated with DSA and MVI. Combined treatment with high-dose IVIG and pulse steroids may be effective in treatment of PCRR resulting in a good long-term graft survival. To our knowledge, this is also the first report of PCRR in a patient with SLKT.