Plasma cell infiltrates and renal allograft outcomes in indigenous and non-indigenous people of the Northern Territory of Australia

• Published in: Nephrology (Carlton, Vic.) Vic.), 2011-11, Vol.16 (8), p.777-783
• Main Authors: ROGERS, NATASHA M, LAWTON, PAUL D, JOSE, MATTHEW D
• Format: Article
• Language: English
• Subjects: Australia - epidemiology; Biopsy; Complement C4b - immunology; Female; Graft Rejection - ethnology; Graft Rejection - immunology; Graft Survival - immunology; Histocompatibility Testing; Humans; Incidence; indigenous; Kaplan-Meier Estimate; kidney transplant; Kidney Transplantation - immunology; Male; Middle Aged; Multivariate Analysis; outcome; Peptide Fragments - immunology; plasma cells; Plasma Cells - immunology; Plasma Cells - pathology; Population Groups - statistics & numerical data; Risk Factors; Transplantation, Homologous
• ISSN: 1320-5358; 1440-1797
• DOI: 10.1111/j.1440-1797.2011.01487.x

Introduction:  Plasma cell‐rich rejection is a distinct histological phenomenon associated with poor renal allograft outcomes. Aboriginal and Torres Straight Islander (ATSI) transplant recipients have poorer allograft survival and higher rates of acute rejection. We sought to determine whether a higher incidence of plasma cell‐rich infiltrates (PCIR) could account for poorer survival. Methods:  Renal transplant biopsies performed in recipients from the Northern Territory of Australia between 1985 and 2007 were reviewed and correlated with outcome. Biopsies were designated PCIR positive when plasma cells constituted >10% of the interstitial infiltrate. Results:  Four hundred and seventy‐seven biopsies from 177 recipients (108 ATSI) were performed. Median graft survival was shorter for recipients with PCIR: 4.0 years (interquartile range 2.18–6.41) versus 5.4 years (2.0–9.99) (P = 0.013). ATSI recipients had higher rates of plasma cell‐rich rejection (RR 1.76, 95% CI 1.43–2.17, P 20% (RR 1.29, 95% CI 1.03–1.56, P = 0.025), ≥5 human leukocyte antigen mismatches (RR 1.91, 1.41–2.58, p 10 infections RR 5.11, 1.69–15.5, P = 0.004), and subsequent death from septicaemia (RR 1.6, 1.17–2.18, P = 0.003). Conclusion:  PCIR is associated with infection and markers of chronic immunological stimulation but does not independently contribute to inferior renal allograft outcomes, even in ATSI recipients. This paper examines renal biopsies from patients in the Northern Territories. Biopsies from Aboriginals and Torres Strait Islanders had an increased incidence of plasma cell‐rich rejection; however, this was not associated with a deleterious effect on graft outcome.