Background: Plasma cell-rich rejection (PCRR) is a rare type of allograft rejection characterized by the presence of mature plasma cells. This type of rejection has been described in a few recent studies and case reports, but the pathogenesis is unknown and a treatment strategy has not been established.

Methods: All kidney allograft biopsies performed between 2001 and 2014 were retrospectively evaluated. PCRR was diagnosed following three criteria. 1. The allograft rejections were pathologically diagnosed according to the Banff 2013 classification. 2. The plasma cells represented more than 30% of total inflammatory cells in the allograft. 3. Cases of bacterial or viral infection, drug-induced nephropathy, or post- transplantation lymphoproliferative disease (PTLD) were excluded.

Result: Nineteen cases met the inclusion criteria. The mean age of patients was 38 ± 16 years. PCRR was diagnosed at a median of 35.7 months after transplantation. The mean baseline serum creatinine was 1.27 ± 0.38 mg/dl and increased to 2.44 ± 1.02 mg/dl at biopsies. Two patients tested positive for circulating donor-specific antibodies. Almost all cases were treated with immunosuppressive therapies such as a high dose of steroids, anti-thymoglobulin, rituximab, or intravenous immunoglobulin. For a median follow-up duration of 55.5 months after rejection, 5 cases (35.7%) lost their allograft.

Conclusion: This study indicated that PCRR had better graft survival compared with previous estimates, but the outcome was still poor.

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