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Value of monitoring circulating donor-reactive memory B cells to characterize antibody-mediated rejection after kidney transplantation.
- Source :
-
American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons [Am J Transplant] 2019 Feb; Vol. 19 (2), pp. 368-380. Date of Electronic Publication: 2018 Sep 17. - Publication Year :
- 2019
-
Abstract
- Antibody-mediated rejection (ABMR) is defined by specific histopathological lesions and evidence of circulating donor-specific antibodies (DSA). Although DSA are not always detectable, monitoring donor-reactive memory B cells (mBC) could identify patients at risk of developing ABMR. Peripheral donor-reactive mBC using a novel HLA B cell ELISpot assay, serum DSA, and numbers of different B cell subsets were assessed in 175 consecutive kidney transplants undergoing either for-cause or 6- and 24-month surveillance biopsies for their association with main histological lesions of ABMR and impact on allograft outcome. In 85 incident for-cause biopsies, high frequencies of donor-reactive mBC were detected in all 16 (100%) acute ABMR/DSA+ and most chronic ABMR, with or without DSA (24/30[80%] and 21/29[72.4%], respectively). In a longitudinal cohort of 90 nonsensitized patients, a progressively higher expansion of donor-reactive mBC than de novo DSA was observed at 6 and 24 months (8.8% vs 7.7% and 15.5% vs 11.1%, respectively) and accurately identified patients with ongoing subclinical ABMR (area under the curve = 0.917 and area under the curve = 0.809, respectively). An unsupervised hierarchical cluster analysis revealed a strong association between donor-reactive mBC with main fundamental allograft lesions associated with ABMR and conferred a significant deleterious impact on graft outcome. Monitoring donor-reactive mBC may be useful to further characterize humoral rejection after kidney transplantation.<br /> (© 2018 The American Society of Transplantation and the American Society of Transplant Surgeons.)
- Subjects :
- Allografts
Cross-Sectional Studies
Female
Follow-Up Studies
Glomerular Filtration Rate
Graft Rejection etiology
Graft Rejection pathology
HLA Antigens immunology
Humans
Isoantibodies blood
Kidney Function Tests
Longitudinal Studies
Male
Middle Aged
Postoperative Complications
Prognosis
Prospective Studies
Risk Factors
Tissue Donors statistics & numerical data
B-Lymphocytes immunology
Graft Rejection diagnosis
Graft Survival immunology
Immunologic Memory immunology
Isoantibodies immunology
Kidney Failure, Chronic surgery
Kidney Transplantation adverse effects
Subjects
Details
- Language :
- English
- ISSN :
- 1600-6143
- Volume :
- 19
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons
- Publication Type :
- Academic Journal
- Accession number :
- 30085394
- Full Text :
- https://doi.org/10.1111/ajt.15055