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Abstract: FR-PO783

Plasma Cell Rich Rejection (PCRR) of Kidney Allografts: A Review of 94 Patients

Session Information

Category: Transplantation

  • 2002 Transplantation: Clinical

Authors

  • Khan, Hameeda Tayyab, Weill Cornell Medicine, New York, New York, United States
  • Lin, Jonathan T., Weill Cornell Medicine, New York, New York, United States
  • Salinas, Thalia, Weill Cornell Medicine, New York, New York, United States
  • Salvatore, Steven, Weill Cornell Medicine, New York, New York, United States
  • Dadhania, Darshana M., Weill Cornell Medicine, New York, New York, United States
  • Hartono, Choli, Weill Cornell Medicine, New York, New York, United States
  • Seshan, Surya V., Weill Cornell Medicine, New York, New York, United States
  • Muthukumar, Thangamani, Weill Cornell Medicine, New York, New York, United States
Background

PCRR, defined as an acute rejection in which plasma cells constitute >20% of the cells infiltrating the kidney interstitium, occurs in the context of mixed AMR/TCMR or TCMR. Allograft outcome after PCRR is poor and risk factors have not been well defined.

Methods

We did a chart review of 94 consecutive transplant kidney biopsies (7/2007-12/2021) at our center reported as PCRR. Patients with functioning grafts were censored at 60 months after biopsy diagnosis. Allograft outcome and risk factors were assessed by Kaplan-Meier and Cox regression analysis.

Results

Mean (SD) age of patients was 40 (17) years; 43% were women; 36% were Black. Mean (SD) age of donors was 35 (17) years; 45% were deceased donors; 63% were women; 29% were Black. 83% received Thymoglobulin induction and all were on calcineurin-based immunosuppression. Time (median, IQR) from transplantation to biopsy was 48 (16-75) months. Medication nonadherence was observed in 37%. 75 (80%) patients had mixed acute rejection. Besides methylprednisolone pulse, treatment included combinations of thymoglobulin, intravenous immunoglobulin, plasmapheresis, and bortezomib. During a median follow of 49.8 months, 58 patients lost their grafts. The median allograft survival was 27.5 months (Fig 1). Variables associated with the outcome are shown in Fig 2. Bortezomib-based antirejection therapy did not improve outcome (HR 0.75 [0.39-1.44], P=0.38).

Conclusion

PCRR, irrespective of whether it occurs in the context of mixed AMR/TCMR or TCMR, is associated with poor allograft outcomes. Molecular characterization of PCRR biopsies may provide clues to better understand the pathogenesis and develop targeted therapeutics.

Fig 1

Fig 2