title: Acute cellular rejection with CD20-positive lymphoid clusters in kidney transplant patients following lymphocyte depletion.
abstract: Lymphoid clusters (LC) containing CD20-positive B cells in kidney allografts undergoing acute cellular rejection (ACR) have been identified in small studies as a prognostic factor for glucocorticoid resistance and graft loss. Allograft biopsies obtained during the first episode of ACR in 120 recipients were evaluated for LC, immunostained with CD20 antibody, and correlated with conventional histopathologic criteria, response to treatment and outcome. LC were found in 71 (59%) of the 120 biopsies. All contained CD20 positive B cells that accounted for 5-90% of the LC leukocyte content. The incidence of LC was highest in the patients who had no lymphoid depletion or had been treated with Thymoglobulin preconditioning (79% vs. 75%, respectively) compared to 37% in patients pretreated with Campath (p = 0.0001). Banff 1a/1b ACR were more frequent in the LC-positive than the LC-negative group (96% vs. 80%, respectively; p = 0.0051). With a posttransplant follow-up of 953 +/- 430 days, no significant differences were detected between LC-postitive and LC-negative groups in time to ACR, steroid resistance, serum creatinine and graft loss. CD20+LC did not portend glucocorticoid resistance or worse short to medium term outcomes. CD20+LC may represent a heterogenous collection in which there may be a small still to be fully defined unfavorable subgroup.
authors.affiliation: The Thomas E. Starzl Transplantation Institute, Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA. liisekayler@yahoo.com
authors.forename: L K
authors.initials: LK
authors.lastname: Kayler
authors.forename: F G
authors.initials: FG
authors.lastname: Lakkis
authors.forename: C
authors.initials: C
authors.lastname: Morgan
authors.forename: A
authors.initials: A
authors.lastname: Basu
authors.forename: D
authors.initials: D
authors.lastname: Blisard
authors.forename: H P
authors.initials: HP
authors.lastname: Tan
authors.forename: J
authors.initials: J
authors.lastname: McCauley
authors.forename: C
authors.initials: C
authors.lastname: Wu
authors.forename: R
authors.initials: R
authors.lastname: Shapiro
authors.forename: P S
authors.initials: PS
authors.lastname: Randhawa
mesh_terms: D000208:Acute Disease; D000328:Adult; D000074323:Alemtuzumab; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized; D000912:Antibodies, Neoplasm / Q000627:therapeutic use; D015703:Antigens, CD / Q000276:immunology; D018951:Antigens, CD20 / Q000276:immunology*; D000961:Antilymphocyte Serum / Q000627:therapeutic use; D001402:B-Lymphocytes / Q000276:immunology / Q000473:pathology*; D001706:Biopsy; D005260:Female; D006084:Graft Rejection / Q000188:drug therapy* / Q000276:immunology* / Q000473:pathology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016030:Kidney Transplantation / Q000276:immunology* / Q000473:pathology; D008212:Lymphocyte Depletion / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000912:Antibodies, Neoplasm; D015703:Antigens, CD; D018951:Antigens, CD20; D000961:Antilymphocyte Serum; D007166:Immunosuppressive Agents; D000074323:Alemtuzumab