Abstract: FR-PO783
Plasma Cell Rich Rejection (PCRR) of Kidney Allografts: A Review of 94 Patients
Session Information
- Transplantation: Clinical - Biomarkers
November 04, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
Abstract Time: 10:00 AM - 12:00 PM
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