A case of plasma cell-rich acute rejection 18 months after kidney transplantation successfully treated with steroid pulse therapy

摘要

A 45-yr-old Japanese male underwent living-related kidney transplantation in August 2005, and immunosuppression consisted of tacrolimus, mycophenolate mofetil, methylprednisolone, basiliximab, and rituximab 200 mg. Allograft function was good, and the protocol biopsy post-transplant day 11 showed no evidence of rejection. The serum creati-nine (s-Cr) level was maintained at the 1.2 mg/dL for 18 months. On February 2007, the patient's s-Cr level had increased to 2.03 mg/dL, and an episode biopsy was performed. The biopsy specimen demonstrated moderate to severe tubulitis and moderate interstitial infiltration of plasma cells and lymphocytes. The inflammatory cell infiltrate consisted of >30% plasma cells. The histopathological findings were consistent with plasma cell-rich acute rejection (PCAR). The PCAR was treated by steroid pulse therapy, and his s-Cr level decreased to 1.58 mg/dL. A biopsy three months after the steroid pulse therapy showed no evidence of rejection. The patient's allograft function is currently stable, and s-Cr level is 1.7 mg/dL. This is a case of PACR, that was successfully treated with steroid pulse therapy alone.