BACKGROUND: Some patients sensitized to HLA antigens do not have antibody present in serum specimens that are available before transplantation. However, such patients are at risk for an anamnestic response resulting from a proinflammatory response to the trauma of transplant surgery. Quantifying HLA-specific B cells provides a way to identify these patients and provide treatment to prevent an anamnestic response. METHODS: B cells were isolated before transplantation from 59 patients, 20 of whom were treated with rituximab at the time of transplantation. Ninety-nine tests were performed to quantify HLA-specific B cells by staining with HLA tetramers. Patients were considered sensitized or nonsensitized based on the frequencies of HLA-specific B cells. Pretransplantation and posttransplantation sera were tested for the detection of antibody specific for the tetramer antigen. RESULTS: Of the 24 cases where patients were considered sensitized to HLA antigens but did not have antibody before transplantation, no posttransplantation antibody to the tetramer antigen was detected in 10 cases when patients were treated with rituximab, but antibody was detected in 13 of 16 cases when there was no rituximab treatment (P=0.00006). The mean frequencies of B cells specific for HLA-B7 were the same in rituximab-treated patients who did not make antibody and in nontreated patients who did make antibody (6.0% vs. 5.7%; P=0.8). CONCLUSIONS: Elimination of peripheral HLA-specific B cells in patients who are sensitized to HLA antigens but lacking detectable antibody abrogates an anamnestic response.
BACKGROUND: Some patients sensitized to HLA antigens do not have antibody present in serum specimens that are available before transplantation. However, such patients are at risk for an anamnestic response resulting from a proinflammatory response to the trauma of transplant surgery. Quantifying HLA-specific B cells provides a way to identify these patients and provide treatment to prevent an anamnestic response. METHODS: B cells were isolated before transplantation from 59 patients, 20 of whom were treated with rituximab at the time of transplantation. Ninety-nine tests were performed to quantify HLA-specific B cells by staining with HLA tetramers. Patients were considered sensitized or nonsensitized based on the frequencies of HLA-specific B cells. Pretransplantation and posttransplantation sera were tested for the detection of antibody specific for the tetramer antigen. RESULTS: Of the 24 cases where patients were considered sensitized to HLA antigens but did not have antibody before transplantation, no posttransplantation antibody to the tetramer antigen was detected in 10 cases when patients were treated with rituximab, but antibody was detected in 13 of 16 cases when there was no rituximab treatment (P=0.00006). The mean frequencies of B cells specific for HLA-B7 were the same in rituximab-treated patients who did not make antibody and in nontreated patients who did make antibody (6.0% vs. 5.7%; P=0.8). CONCLUSIONS: Elimination of peripheral HLA-specific B cells in patients who are sensitized to HLA antigens but lacking detectable antibody abrogates an anamnestic response.
Authors: Malte Ziemann; Wolfgang Altermann; Katharina Angert; Wolfgang Arns; Anette Bachmann; Tamam Bakchoul; Bernhard Banas; Annette von Borstel; Klemens Budde; Vanessa Ditt; Gunilla Einecke; Ute Eisenberger; Thorsten Feldkamp; Siegfried Görg; Martina Guthoff; Antje Habicht; Michael Hallensleben; Falko M Heinemann; Nicole Hessler; Christian Hugo; Matthias Kaufmann; Teresa Kauke; Martina Koch; Inke R König; Christine Kurschat; Claudia Lehmann; Matthias Marget; Anja Mühlfeld; Martin Nitschke; Luiza Pego da Silva; Carmen Quick; Axel Rahmel; Thomas Rath; Petra Reinke; Lutz Renders; Florian Sommer; Bernd Spriewald; Oliver Staeck; Dirk Stippel; Caner Süsal; Bernhard Thiele; Daniel Zecher; Nils Lachmann Journal: Clin J Am Soc Nephrol Date: 2019-06-18 Impact factor: 10.614
Authors: Annette M Jackson; Edward S Kraus; Babak J Orandi; Dorry L Segev; Robert A Montgomery; Andrea A Zachary Journal: Kidney Int Date: 2014-07-23 Impact factor: 10.612