title: High B-cell activating factor is not associated with worse 3-year graft outcome in blood group-incompatible kidney transplantation with rituximab induction.
abstract: B cells and their regulation by B-cell activating factor BAFF are of growing interest in kidney transplantation (KTx). There is evidence that high serum (s) BAFF leads to increased allosensitization and impaired long-term graft function. We prospectively investigated sBAFF, peripheral blood lymphocytes (PBL), and donor-specific HLA antibodies (DSA) in patients after ABOi with B-cell depleting rituximab induction treatment and compared them to a group of blood group-compatible (ABOc) living donor kidney recipients. Twelve patients after ABOi and 18 after ABOc were included. After rituximab treatment prior to ABOi, B cells remained significantly lower 1 year after KTx (1.2% (0.0-17.8) compared to ABOc of 8.6% (2.8-35.0), p = 0.0004, and also BAFF-R expression was significantly lower in ABOi (p < 0.006). sBAFF remained elevated 1 year post-Tx compared to ABOc (3615 ± 1800 vs. 1394 ± 493 pg/mL, p < 0.004). Kidney function was not significantly different between both groups after 1, 2, and 3 years. The use of rituximab in ABOi together with maintenance immunosuppression leads to significant elevation of sBAFF and lowering of B-cell numbers for more than 1 year, and this does not correlate with worse 3-year graft outcome.
authors: Department of Hepatobiliary Surgery and Transplantation at University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Pediatric Nephrology at University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors: Anja M
authors: AM
authors: Lehnhardt
authors: Maximiliane
authors: M
authors: Strecker
authors: Thomas
authors: T
authors: Eiermann
authors: Matthias
authors: M
authors: Marget
authors: Friedrich
authors: F
authors: Thaiss
authors: Björn
authors: B
authors: Nashan
authors: Martina
authors: M
authors: Koch
mesh_terms: D000017:ABO Blood-Group System / Q000276:immunology*; D000328:Adult; D053264:B-Cell Activating Factor / Q000276:immunology*; D001402:B-Lymphocytes / Q000276:immunology*; D001787:Blood Group Incompatibility / Q000276:immunology*; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005434:Flow Cytometry; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D007155:Immunologic Factors / Q000276:immunology / Q000627:therapeutic use; D007676:Kidney Failure, Chronic / Q000276:immunology* / Q000601:surgery; D007677:Kidney Function Tests; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011379:Prognosis; D012307:Risk Factors; D000069283:Rituximab / Q000276:immunology* / Q000627:therapeutic use
chemical_list: D000017:ABO Blood-Group System; D053264:B-Cell Activating Factor; D007155:Immunologic Factors; C505719:TNFSF13B protein, human; D000069283:Rituximab
keywords: B cells; BAFF; biomarker; kidney transplantation; rituximab