title: Expression patterns of B cells in acute kidney transplant rejection.
abstract: OBJECTIVE
  To evaluate B-cell expression patterns and association with function and survival in dysfunctional kidney allografts.
  
  
  METHODS
  There were 110 kidney transplant recipients included who had for-cause biopsies. Demographic and transplant data were collected. Immunostaining for B cells, plasma cells, and C4d was performed by the immunoperoxidase technique in paraffin-embedded samples. Circulating antihuman leukocyte antigen donor-specific antibodies were detected in a single-antigen assay at biopsy. The main outcomes were kidney graft survival and function. The patients were evaluated in 3 groups according to the Banff classification: no rejection (40 patients), T-cell-mediated rejection (50 patients), and antibody-mediated rejection (20 patients).
  
  
  RESULTS
  The CD138-positive plasma cell-rich infiltrates predominated in antibody-mediated rejection and were associated with stronger reactivity against panel antibodies (r = 0.41; P ≤ .001) and positive donor-specific antibodies (r = 0.32; P ≤ .006). The CD20-positive lymphocytes were associated with T-cell-mediated rejection, increased human leukocyte antigen mismatch, and frequency of retransplant. The CD138-positive cell infiltrates also were significantly greater in patients who had late than early rejection. There was no correlation between cellular CD20 and CD138 expression, and neither CD20 nor CD138 predicted worse graft function or survival. Other markers of antibody-mediated rejection such as C4d and donor-specific antibodies were associated with worse graft function and survival at 4 years after transplant. In multivariate analysis, C4d was the only risk factor associated with graft loss.
  
  
  CONCLUSIONS
  After kidney transplant, CD20-positive B-cell infiltrates were associated with T-cell-mediated rejection, and CD138-positive plasma cells were associated with antibody-mediated rejection. Graft loss was associated with the presence of C4d.
authors.affiliation: From the Postgraduate Program in Medicine/Medical Sciences, Federal University of Rio Grande do Sul, Division of Nephrology and Laboratory of Molecular Biology Applied to Nephrology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil.
authors.forename: Virna Nowotny
authors.initials: VN
authors.lastname: Carpio
authors.forename: Irene de Lourdes
authors.initials: Ide L
authors.lastname: Noronha
authors.forename: Hugo Ludovico
authors.initials: HL
authors.lastname: Martins
authors.forename: Luiz Fernando
authors.initials: LF
authors.lastname: Jobim
authors.forename: Beatriz Chamun
authors.initials: BC
authors.lastname: Gil
authors.forename: Adriane Silva
authors.initials: AS
authors.lastname: Külzer
authors.forename: Melina da Silva
authors.initials: Mda S
authors.lastname: Loreto
authors.forename: Luiz Felipe Santos
authors.initials: LF
authors.lastname: Gonçalves
authors.forename: Roberto Ceratti
authors.initials: RC
authors.lastname: Manfro
authors.forename: Francisco Veríssimo
authors.initials: FV
authors.lastname: Veronese
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D018951:Antigens, CD20 / Q000032:analysis; D001323:Autoantibodies / Q000097:blood; D001402:B-Lymphocytes / Q000276:immunology* / Q000378:metabolism; D015415:Biomarkers / Q000032:analysis; D001706:Biopsy; D016009:Chi-Square Distribution; D015935:Complement C4b / Q000032:analysis; D005260:Female; D006084:Graft Rejection / Q000097:blood / Q000175:diagnosis / Q000276:immunology*; D006085:Graft Survival; D006680:HLA Antigens / Q000276:immunology; D006801:Humans; D007150:Immunohistochemistry; D053208:Kaplan-Meier Estimate; D007668:Kidney / Q000276:immunology* / Q000378:metabolism / Q000473:pathology; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010446:Peptide Fragments / Q000032:analysis; D010950:Plasma Cells / Q000276:immunology; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D053668:Syndecan-1 / Q000032:analysis; D013601:T-Lymphocytes / Q000276:immunology* / Q000378:metabolism; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D018951:Antigens, CD20; D001323:Autoantibodies; D015415:Biomarkers; D006680:HLA Antigens; D010446:Peptide Fragments; C508241:SDC1 protein, human; D053668:Syndecan-1; D015935:Complement C4b; C032261:complement C4d