title: Elevated pretransplantation soluble BAFF is associated with an increased risk of acute antibody-mediated rejection.
abstract: BACKGROUND
  B cells play an important role in renal allograft pathology, particularly in acute and chronic antibody-mediated rejection (AMR). B-cell activating factor belonging to the tumor necrosis factor family (BAFF; also known as BLyS) is a cytokine that enhances B-cell survival and proliferation.
  
  
  METHODS
  We analyzed serum BAFF levels in 32 patients undergoing antibody-incompatible (Ai) renal transplantation and 319 antibody-compatible transplant recipients and sought to determine whether there was a correlation with acute rejection and with transplant function and survival.
  
  
  RESULTS
  We demonstrate that, in patients undergoing Ai transplantation, elevated serum BAFF levels at baseline (before both antibody removal/desensitization and transplantation) are associated with an increased risk of subsequent AMR. In antibody-compatible transplant recipients at lower risk of AMR, no statistically significant association was observed between pretransplantation serum BAFF and AMR.
  
  
  CONCLUSIONS
  These data raise the possibility that, in high immunologic risk patients undergoing Ai transplantation, the presence of elevated pretransplantation serum BAFF might identify those at increased risk of AMR. BAFF neutralization may be an interesting therapeutic strategy to explore in these patients, particularly because such agents are available and have already been used in the treatment of autoimmunity.
authors.affiliation: Department of Medicine, University of Cambridge, Francis Crick Avenue, Cambridge Biomedical Campus, Cambridge, UK.
authors.forename: Gemma
authors.initials: G
authors.lastname: Banham
authors.forename: Davide
authors.initials: D
authors.lastname: Prezzi
authors.forename: Sarah
authors.initials: S
authors.lastname: Harford
authors.forename: Craig J
authors.initials: CJ
authors.lastname: Taylor
authors.forename: Rizwan
authors.initials: R
authors.lastname: Hamer
authors.forename: Rob
authors.initials: R
authors.lastname: Higgins
authors.forename: J Andrew
authors.initials: JA
authors.lastname: Bradley
authors.forename: Menna R
authors.initials: MR
authors.lastname: Clatworthy
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D053264:B-Cell Activating Factor / Q000097:blood*; D001402:B-Lymphocytes / Q000276:immunology; D015415:Biomarkers / Q000097:blood; D015331:Cohort Studies; D005260:Female; D006084:Graft Rejection / Q000097:blood / Q000209:etiology* / Q000276:immunology; D006680:HLA Antigens; D006801:Humans; D007518:Isoantibodies / Q000097:blood; D007676:Kidney Failure, Chronic / Q000097:blood / Q000276:immunology / Q000601:surgery; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D012995:Solubility; D016019:Survival Analysis; D055815:Young Adult
chemical_list: D053264:B-Cell Activating Factor; D015415:Biomarkers; D006680:HLA Antigens; D007518:Isoantibodies; C505719:TNFSF13B protein, human