Plasma cell-rich rejection – The enigma revisited: Case report

Plasma cell-rich rejection (PCRR) is a morphological pattern of rejection characterized by the presence of plasma cells constituting at least 10% of the cellular infiltrate. Clinical characteristics, therapeutic options, and its position in the Banff Classification for Allograft Rejection have not been clearly defined. Although morphologically discussed in close association with cellular rejection, histopathological advances and better availability of C4d helped us to understand the close relationship with the antibody-mediated rejection. T helper cell 2 predominant cellular infiltration has been identified in recent studies. Rational choices of drugs such as bortezomib have not shown outcomes as expected in various clinical trials. Newer therapeutic options directed at TH2 cytokines which are being tested in other disorders may open up new avenues of therapy. We discuss two cases of PCRR with varied presentation, one early and the other very late in the course of transplantation. Both of our patients had poor graft outcomes despite therapy.