CASE 02: Acute Plasma Cell-Rich Allograft Rejection

51-year-old man with end stage polycystic kidney disease. Received a deceased donor kidney transplant 7 years prior to current presentation. Maintained on MMF, prednisone, and tacrolimus. Prior history of rejection. Average creatinine around 1.0 mg/dl. Lost to follow up for 10 months. Admits missing several doses of his immunosuppression medications. Current creatinine 5.5.

Allograft biopsy shows extensive interstitial edema and plasma cell-rich infiltrate. Tubules appear distended with flattening of the epithelial layer. These features suggest late acute plasma cell-rich allograft rejection that is associated with under-treatment or poor compliance with immunosuppressive treatment. In general, prognosis is poor.