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Plasma-cell-rich infiltrates in paediatric renal transplant biopsies are associated with increased risk of renal allograft failure

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Abstract

Background

Increased plasma cell infiltration in renal allograft biopsies is a rare finding associated with poor outcome in adult renal transplant recipients. The clinical impact of increased plasma cell infiltrates in paediatric renal transplant recipients (pRTR) remains unknown.

Methods

We conducted a retrospective case–control study from April 1996 to March 2014 comparing the outcome of pRTR with increased (>10 % of infiltrate) plasma cells in renal transplant biopsies to a control cohort of pRTR without increased plasma cell infiltration but similar grade of rejection according to Banff classification.

Results

Increased plasma cell infiltrates were present in 14 of 162 (9 %) reviewed pRTR aged 3.2–17.5 (median 13.4) years at time of transplantation. Compared with 14 pRTR renal transplant biopsies without significantly increased plasma cells, there were no significant differences in mismatch and baseline estimated glomerular filtration rate (eGFR). Plasma cells were present in case biopsies at a maximal density of 14–116 (median 33) plasma cells/HPF. Increased plasma cells were associated with decreased eGFR at biopsy (22 vs. 49 ml/min/1.73 m2; p < 0.001) and 4 weeks post-biopsy (26 vs. 56 ml/min/1.73 m2; p < 0.001) despite comparable eGFR 4 weeks prior to biopsy. Increased plasma cells were further associated with significantly increased frequency of renal allograft loss (71 % vs. 7 %; p < 0.001) at 0–27 (median 2) months after biopsy.

Conclusion

Increased plasma cell infiltrates in pRTR are uncommon but associated with significantly reduced renal allograft survival as well as significantly reduced allograft function in surviving grafts.

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Abbreviations

AR:

Acute rejection

DD:

Deceased donor

EBV:

Epstein-Barr virus

eGFR:

estimated glomerular filtration rate

LRD:

Living related donor

MMF:

Mycophenolate mofetil

PCAR:

Plasma-cell-rich acute rejection

pRTR:

Paediatric renal transplant recipient

PTLD:

Posttransplant lymphoproliferative disorder

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Acknowledgments

This research was supported by the National Institute for Health Research Biomedical Research Centres at Great Ormond Street Hospital for Children NHS Foundation Trust, University College London, Guy’s and St Thomas’ NHS Foundation Trust and King’s College London. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.

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Authors and Affiliations

  1. Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK

    Stephanie Dufek, Azaz Khalil & Stephen D. Marks

  2. Guy and St Thomas Hospital NHS Foundation Trust, London, UK

    Nizam Mamode

  3. Department of Paediatric Pathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK

    Neil J. Sebire

Authors
  1. Stephanie Dufek
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  2. Azaz Khalil
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  3. Nizam Mamode
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  4. Neil J. Sebire
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  5. Stephen D. Marks
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Corresponding author

Correspondence to Stephen D. Marks.

Ethics declarations

Ethical approval was obtained for our renal transplant cohort from the Institute of Child Health and Great Ormond Street Hospital ethics committee.

Conflict of interest

The results presented in this paper have not been published previously in whole or part, except in abstract form. The authors declare that they have no conflict of interest.

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Dufek, S., Khalil, A., Mamode, N. et al. Plasma-cell-rich infiltrates in paediatric renal transplant biopsies are associated with increased risk of renal allograft failure. Pediatr Nephrol 32, 679–684 (2017). https://doi.org/10.1007/s00467-016-3524-0

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  • DOI: https://doi.org/10.1007/s00467-016-3524-0

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