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

Uppin MS, Gudithi S, Taduri G, Prayaga AK, Raju SB - Indian J Nephrol (2016 May-Jun)

Bottom Line: DSA was positive in six patients.All the patients were treated with standard therapeutic measures of acute cellular rejection (ACR) and ABMR including steroids, plasma exchange, rituximab and intravenous immunoglobulins.All the patients had persistent graft dysfunction or graft loss on follow-up.

View Article: PubMed Central - PubMed

Affiliation: Department of Pathology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India.

ABSTRACT
Renal allograft rejection is mediated by T-cells (T-cell mediated rejection) or by donor-specific antibodies (DSAs) (antibody mediated rejection, ABMR). Plasma cell-rich acute rejection (PCAR) is a unique entity due to its peculiar morphology and poor prognostic behavior. All allograft biopsies done at our center from January 2013 to October 2014 were reviewed, and seven were identified with a diagnosis of PCAR with antibody mediated rejection (ABMR). The allograft biopsies were classified as per the Banff 2007 schema. Immunohistochemistry with C4d, SV 40, CD3, CD20, CD138, kappa and lambda light chain was performed. Total 210 allograft biopsies were performed in the study period of which seven biopsies (3.3%) were diagnosed as PCAR with ABMR. All these were late ABMRs (more than 6 months) with median posttransplant duration of 17 months. The allograft biopsy showed features of PCAR along with glomerulitis, peritubular capillaritis, and positive C4d. DSA was positive in six patients. All the patients were treated with standard therapeutic measures of acute cellular rejection (ACR) and ABMR including steroids, plasma exchange, rituximab and intravenous immunoglobulins. All the patients had persistent graft dysfunction or graft loss on follow-up.

No MeSH data available.


Related in: MedlinePlus

(a and b) Immunohistochemical positivity for C4d along the peritubular capillaries (c) positivity of plasma cells for CD 138
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Figure 4: (a and b) Immunohistochemical positivity for C4d along the peritubular capillaries (c) positivity of plasma cells for CD 138

Mentions: All the biopsies showed morphologic features of ACR in the form of interstitial inflammation and tubulitis as well as ABMR such as peritubular capillaritis, glomerulitis, and intimal arteritis [Figures 2 and 3]. The features of chronicity were absent/minimal in these biopsies. The scoring for acute/active and chronic lesions is provided in Table 3. All the biopsies showed C4d positivity in peritubular capillaries (c4d3) [Figure 4].


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

Uppin MS, Gudithi S, Taduri G, Prayaga AK, Raju SB - Indian J Nephrol (2016 May-Jun)

(a and b) Immunohistochemical positivity for C4d along the peritubular capillaries (c) positivity of plasma cells for CD 138
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4862262&req=5

Figure 4: (a and b) Immunohistochemical positivity for C4d along the peritubular capillaries (c) positivity of plasma cells for CD 138
Mentions: All the biopsies showed morphologic features of ACR in the form of interstitial inflammation and tubulitis as well as ABMR such as peritubular capillaritis, glomerulitis, and intimal arteritis [Figures 2 and 3]. The features of chronicity were absent/minimal in these biopsies. The scoring for acute/active and chronic lesions is provided in Table 3. All the biopsies showed C4d positivity in peritubular capillaries (c4d3) [Figure 4].

Bottom Line: DSA was positive in six patients.All the patients were treated with standard therapeutic measures of acute cellular rejection (ACR) and ABMR including steroids, plasma exchange, rituximab and intravenous immunoglobulins.All the patients had persistent graft dysfunction or graft loss on follow-up.

View Article: PubMed Central - PubMed

Affiliation: Department of Pathology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India.

ABSTRACT
Renal allograft rejection is mediated by T-cells (T-cell mediated rejection) or by donor-specific antibodies (DSAs) (antibody mediated rejection, ABMR). Plasma cell-rich acute rejection (PCAR) is a unique entity due to its peculiar morphology and poor prognostic behavior. All allograft biopsies done at our center from January 2013 to October 2014 were reviewed, and seven were identified with a diagnosis of PCAR with antibody mediated rejection (ABMR). The allograft biopsies were classified as per the Banff 2007 schema. Immunohistochemistry with C4d, SV 40, CD3, CD20, CD138, kappa and lambda light chain was performed. Total 210 allograft biopsies were performed in the study period of which seven biopsies (3.3%) were diagnosed as PCAR with ABMR. All these were late ABMRs (more than 6 months) with median posttransplant duration of 17 months. The allograft biopsy showed features of PCAR along with glomerulitis, peritubular capillaritis, and positive C4d. DSA was positive in six patients. All the patients were treated with standard therapeutic measures of acute cellular rejection (ACR) and ABMR including steroids, plasma exchange, rituximab and intravenous immunoglobulins. All the patients had persistent graft dysfunction or graft loss on follow-up.

No MeSH data available.


Related in: MedlinePlus