The Presence of B-Cell Nodules Does Not Necessarily Portend a Less Favorable Outcome to Therapy in Patients With Acute Cellular Rejection of a Renal Allograft

• Published in: Transplantation proceedings 2006-12, Vol.38 (10), p.3441-3444
• Main Authors: Doria, C., di Francesco, F., Ramirez, C.B., Frank, A., Iaria, M., Francos, G., Marino, I.R., Farber, J.L.
• Format: Article
• Language: English
• Subjects: Acute Disease; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Antigens, CD - analysis; Applied cell therapy and gene therapy; B-Lymphocytes - immunology; B-Lymphocytes - pathology; Biological and medical sciences; CD3 Complex - analysis; CD4-Positive T-Lymphocytes - immunology; CD8-Positive T-Lymphocytes - immunology; Complement C4b - analysis; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Graft Rejection - immunology; Graft Rejection - pathology; Humans; Kidney Transplantation - immunology; Kidney Transplantation - pathology; Macrophages - pathology; Medical sciences; Peptide Fragments - analysis; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Tissue, organ and graft immunology; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Treatment Outcome
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2006.10.173

The presence of B-cell nodules in kidney biopsies of patients undergoing acute renal allograft rejection has been reported to be associated with glucocorticoid resistance and a high risk of graft failure. In an attempt to corroborate this observation, biopsies of renal transplants that evidenced Banff grade I A acute rejection were examined for the presence of B- or T-cell nodules, the detection of which was correlated with the therapeutic response. Biopsies from 14 consecutive renal transplant recipients with a diagnosis of acute cellular rejection were examined for the presence of T (CD3-positive) or B (CD20-positive) cells by immunohistochemistry. All patients were biopsied because of a rise in serum creatinine. No biopsy showed evidence of acute humoral rejection. Immunofluorescence microscopy was negative for C4d deposition in peritubular capillaries. There were no neutrophils in the peritubular or glomerular capillaries. Five patients had T-cell nodules; four had B-cell nodules; three had both T- and B-cell nodules; two had no nodules. All biopsies contained CD3-positive cells in the tubules and in the interstitium. In all but one of the patients, episodes of acute rejection were treated with steroids (one received thymoglobulin). Furthermore two patients received mycophenolate mofetil and one, sirolimus. There were no significant differences among the groups in either the initial creatinine or the creatinine after therapy. The presence of B-cell nodules in renal allograft biopsies of patients experiencing acute cellular rejection did not portend a less favorable outcome.