Background: The highly successful induction drug Alemtuzumab (Campath) is commonly used prior to renal transplant. Yet, it does not completely ablate plasma cell which, in a significant number of cases, allows for their accumulation and subsequent immunological contribution to renal rejection. Here, we examine renal biopsies of patients who suffered rejection after treatment with Campath, looking specifically at plasma cells to establish demographics of patients and frequencies of rejection.

Materials and methods: This is an IRB approved retrospective analysis of a prospectively maintained database.

Results: A total of 665 patients induced with Alemtuzumab were identified with 179 suffering rejection (26.92%). Of the patients who suffered rejection, 16.6% showed plasma cells in their renal biopsies. In terms of gender, 70.0% were male and 30% were female (p=0.416). Of patients age 65 and over, 6.6% had plasma cells vs patient younger than 65 years of age, where 4.3% showed plasma cells (p=0.471). In terms of ethnicity, frequency varied among race. White race showed the highest frequency of plasma cells(76.7%),followed by Black (10.0%), Hispanic (6.7%), Asia (3.3%) and Other (3.3%)(p=0.125). In terms of Banff score, percentages varied: Banff I (13.3%), II (53.3%), III (3.3%), and 30% were not recorded. When PRA was examined, no patient with a score greater then 20 showed any incidence of plasma cells with rejection, all patients with plasma cells had a PRA <20. In terms of C4d, 40.6% of patients positive for plasma cells were also positive for C4d. In terms of outcomes, 10% of the patients with plasma cells experienced graph failure.

Conclusion: Plasma cells are under reported in the transplant community but are gaining notoriety. Here, we report finding plasma cells in a significant number of cases with increased frequencies occurring in patient with specific risk factors, which warrants further investigation.

CITATION INFORMATION: Mugge L, Zimmerman A, Varshney N, Gohara A, Rees M, Ortiz J. Plasma Cell Frequency in Renal Rejection After Treatment with Alemtuzumab. Am J Transplant. 2016;16 (suppl 3).

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