Emerging role of B cells in chronic allograft dysfunction.
B cells have many possible mechanisms by which they can affect allograft survival, including antigen presentation, cytokine production, immune regulation, and differentiation into alloantibody-producing plasma cells. This report reviews the last mechanism, which the authors regard as most critical for the long-term survival of allografts, namely, the promotion of chronic rejection by alloantibodies. Chronic humoral rejection characteristically arises late after transplantation and causes transplant glomerulopathy, multilamination of peritubular capillary basement membranes, and C4d deposition in PTCs and glomeruli. Circulating antidonor human leukocyte antigen class II antibodies are commonly detected and may precede the development of graft injury. Prognosis is poor, especially when recognized after graft dysfunction has developed. Improved detection and treatment are critically needed for this common cause of late graft loss.
Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114, USA. colvin@helix.mgh.harvard.edu
Robert B
RB
Colvin
Tsutomu
T
Hirohashi
Alton B
AB
Farris
Francesca
F
Minnei
A Bernard
AB
Collins
R Neal
RN
Smith
D000818:Animals; D001402:B-Lymphocytes / Q000276:immunology*; D002908:Chronic Disease; D006084:Graft Rejection / Q000276:immunology* / Q000517:prevention & control; D006801:Humans; D056724:Immunity, Humoral; D007165:Immunosuppression Therapy / Q000379:methods; D007518:Isoantibodies / Q000096:biosynthesis; D007519:Isoantigens / Q000276:immunology; D007668:Kidney / Q000276:immunology* / Q000503:physiopathology; D007674:Kidney Diseases / Q000276:immunology* / Q000503:physiopathology / Q000517:prevention & control; D016030:Kidney Transplantation / Q000009:adverse effects*; D013997:Time Factors; D014184:Transplantation, Homologous; D016896:Treatment Outcome
D007518:Isoantibodies; D007519:Isoantigens