{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,10]],"date-time":"2025-12-10T12:18:15Z","timestamp":1765369095172},"reference-count":15,"publisher":"Wiley","issue":"S1","license":[{"start":{"date-parts":[[2016,6,24]],"date-time":"2016-06-24T00:00:00Z","timestamp":1466726400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Nephrology"],"published-print":{"date-parts":[[2016,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>A 56\u2010year\u2010old man who had undergone cadaveric kidney transplantation 21\u2009months earlier was admitted to our hospital for a protocol biopsy; he had a serum creatinine level of 1.2\u2009mg\/dL and no proteinuria. Histological features showed two distinct entities: (i) inflammatory cell infiltration, in the glomerular and peritubular capillaries and (ii) focal, aggressive tubulointerstitial inflammatory cell infiltration, predominantly plasma cells, with mild tubulitis (Banff 13 classification: i2, t1, g2, ptc2, v0, ci1, ct1, cg0, cv0). Immunohistological studies showed mildly positive C4d immunoreactivity in the peritubular capillaries. The patient had donor specific antibody to human\u2010leucocyte\u2010antigen\u2010DR53. We diagnosed him with subclinical antibody\u2010mediated rejection accompanied by plasma cell\u2010rich acute rejection. Both antibody\u2010mediated rejection due to anti\u2010 human\u2010leucocyte\u2010antigen \u2010DR53 antibodies and plasma cell\u2010rich acute rejection are known to be refractory and have a poor prognosis. Thus, we started plasma exchange with intravenous immunoglobulin and rituximab for the former and 3\u2009days of consecutive steroid pulse therapy for the latter. Three months after treatment, a follow\u2010up allograft biopsy showed excellent responses to treatment for both histological features. This case report considers the importance of an early diagnosis and appropriate intervention for subclinical antibody\u2010mediated rejection due to donor specific antibody to human\u2010leucocyte\u2010antigen\u2010DR53 and plasma cell\u2010rich acute rejection.<\/jats:p>","DOI":"10.1111\/nep.12772","type":"journal-article","created":{"date-parts":[[2016,3,14]],"date-time":"2016-03-14T06:33:28Z","timestamp":1457937208000},"page":"31-34","update-policy":"http:\/\/dx.doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Subclinical antibody\u2010mediated rejection due to anti\u2010human\u2010leukocyte\u2010antigen\u2010DR53 antibody accompanied by plasma cell\u2010rich acute rejection in a patient with cadaveric kidney transplantation"],"prefix":"10.1111","volume":"21","author":[{"given":"Ai","family":"Katsuma","sequence":"first","affiliation":[{"name":"Division of Nephrology and Hypertension, Department of Internal Medicine The Jikei University 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