title: B-cell activating factor, a predictor of antibody mediated rejection in kidney transplantation recipients.
abstract: OBJECTIVE
  Donor-specific antibody (DSA) is a widely-used biomarker for antibody-mediated rejection (ABMR) but correctly indicates only 30-40% of patients with ABMR. Additional biomarkers of ABMR in kidney transplant recipients are needed.
  
  
  METHODS
  All 68 kidney transplanted-recipients enrolled in this study were negative for graft rejection as determined by surveillance-biopsy ELISA at day 7 post-transplantation. Allograft biopsy was then performed at 6 months post-transplantation for subclinical-ABMR detection. Recipients were stratified by pre-transplant DSA and BAFF at day 7 into four groups.
  
  
  RESULTS
  During the study period, 13.2% of the recipients demonstrated subclinical-ABMR at 6 months, without patient with clinical ABMR presentations. Overall mean BAFF at day 7 was 393 pg/mL (95% CI = 316-471 pg/mL). The optimal cut-off value for low vs. high BAFF level was 573 pg/mL, with sensitivity and specificity at 77.8% and 88.1%, respectively. Fifty percent of recipients with high BAFF at day 7 (14 patients) and only 3.7% of patients with low BAFF demonstrated ABMR (P < 0.05). Indeed, ABMR was more common in patients high BAFF level (hazard ratio = 7.30; 95% CI = 3.77-14.15). The prevalence of ABMR among negative pre-transplant DSA/low BAFF, positive DSA/low BAFF, negative DSA/high BAFF, and positive DSA/ high BAFF recipients were 4.4, 0, 37.5 and 66.7%, respectively (P < 0.05).
  
  
  CONCLUSIONS
  Post-transplant ABMR can be predicted by perioperative serum BAFF level. Together with DSA testing, BAFF provides additional predictive value for ABMR.
authors.affiliation: Division of Nephrology, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
authors.forename: Wannarat
authors.initials: W
authors.lastname: Pongpirul
authors.affiliation: Division of Nephrology, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
authors.forename: Wiwat
authors.initials: W
authors.lastname: Chancharoenthana
authors.affiliation: Department of Preventive and Social Medicine, Chulalongkorn University, Bangkok, Thailand.|Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
authors.forename: Krit
authors.initials: K
authors.lastname: Pongpirul
authors.affiliation: Division of Immunology, Department of Microbiology, Chulalongkorn University, Bangkok, Thailand.
authors.forename: Asada
authors.initials: A
authors.lastname: Leelahavanichkul
authors.affiliation: Department of Pathology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
authors.forename: Wipawee
authors.initials: W
authors.lastname: Kittikowit
authors.affiliation: Division of Infectious Disease, Department of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
authors.forename: Kamonwan
authors.initials: K
authors.lastname: Jutivorakool
authors.affiliation: Department of Surgery, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
authors.forename: Bunthoon
authors.initials: B
authors.lastname: Nonthasoot
authors.affiliation: Division of Nephrology, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
authors.forename: Yingyos
authors.initials: Y
authors.lastname: Avihingsanon
authors.affiliation: Division of Nephrology, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
authors.forename: Somchai
authors.initials: S
authors.lastname: Eiam-Ong
authors.affiliation: Division of Nephrology, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
authors.forename: Kearkiat
authors.initials: K
authors.lastname: Praditpornsilpa
authors.affiliation: Division of Nephrology, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
authors.forename: Natavudh
authors.initials: N
authors.lastname: Townamchai
mesh_terms: D000328:Adult; D053264:B-Cell Activating Factor / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006084:Graft Rejection / Q000097:blood* / Q000175:diagnosis / Q000276:immunology; D006085:Graft Survival; D006648:Histocompatibility; D006650:Histocompatibility Testing; D006801:Humans; D056724:Immunity, Humoral; D007518:Isoantibodies / Q000097:blood; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D015854:Up-Regulation
chemical_list: D053264:B-Cell Activating Factor; D015415:Biomarkers; D007518:Isoantibodies; C505719:TNFSF13B protein, human
keywords: B-cell activating factor; Donor specific antibody; Kidney transplantation; antibody mediated rejection