CD20+ Lymphocytes in Renal Allografts Are Associated with Poor Graft Survival in Pediatric Patients

Abstract

This study shows a significant 4.5-fold risk of graft failure at two years postbiopsy with presence of > or =2 CD20+ cells/hpf. Moreover, > or =3 CD20+ lymphocytes were highly associated with acute cellular rejection. They may be functioning as professional antigen-presenting cells in the graft. In steroid-refractory cellular rejections, therapies that target B cells may prolong graft survival.

B Cells Limit Repair after Ischemic Acute Kidney Injury

“…It already has been reported that B cell infiltration is involved in allograft rejection and poor graft survival. [22][23][24] Our data demonstrate that warm kidney IRI, independent of alloresponses, can cause B cell trafficking to the renal allograft and alter tubular repair process. Furthermore, modulating B cells and targeting CD126 represent a novel way to improve clinical outcomes from kidney IRI.…”

“…19,20 A number of studies have demonstrated that B cells infiltrate into renal allografts and contribute to rejection 21,22 ; however, the exact role of B cells that have infiltrated into renal allografts is still unclear. Some studies reported that B cells could cause transplant acute cellular rejection as well as humoral rejection and increase the risk for graft failure independent of C4d peritubular deposition, 23,24 whereas other studies have not shown this clinical correlation. 25,26 One recent article characterized intragraft B cells during renal allograft rejection: Both mature B cells and interstitial plasmablasts correlated with circulating donorspecific antibody concentration and poor response to steroid therapy during rejection.…”

Molecular Phenotypes of Acute Rejection Predict Kidney Graft Prognosis

“…26 In our study, there were also trends toward higher expression of markers related to B cell infiltration, such as CD20 within grafts with better prognosis. The B-lymphocyte infiltrate during acute rejection was shown to be associated with poor prognosis in some reports 27,28 although not in others. 29 B cells may be functioning as professional antigen-presenting cells in the graft and thus related to more severe rejection outcome.…”

B lymphocytes in renal interstitial fibrosis

“…In renal transplant rejection, B-cell clusters have been shown to associate with steroid resistance and poorer transplant survival (Hippen et al 2005;Tsai et al 2006). However, there is also study with contradicting results (Jonker et al 2015).…”