Clinical and Pathological Features of Plasma Cell-Rich Acute Rejection after Kidney Transplantation

AbstractBackgroundPlasma cell-rich acute rejection (PCAR) is a rare type of allograft rejection characterized by the presence of mature plasma cells. In general the prognosis of PCAR is poor, and its clinical and pathological features remain unclear.MethodsWe performed a retrospective observational study and compared allograft survival between kidney transplant recipients who developed PCAR and those who did not develop PCAR. We further analyzed clinical and pathological risk factors for allograft failure in PCAR patients.ResultsOf 1,956 recipients, 40 developed PCAR. There was a higher prevalence of deceased donor transplants (27.5% vs. 11.7%, P=0.0059), longer median total ischemia time (99 min, interquartile range: 71 – 144, vs. 77 min, interquartile range: 59 – 111, P=0.0309), and lower prevalence of ABO-incompatible transplantation (7.5% vs. 22.5%, P=0.0206) in patients with PCAR than in those without PCAR.Multivariate Cox regression analysis showed that development of PCAR was associated with allograft loss (Hazard Ratio=8.03, 95% Confidence Interval: 3.89 – 14.80, P

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