Abstract
It is well known that pre-transplant B cell activating factor (BAFF) levels are associated with the development of de novo anti-HLA antibodies and antibody mediated rejection post-transplant. However, the clinical significance of BAFF values at allograft rejection has not been determined. In this study, we investigated the clinical significance of pre-transplant BAFF level as well as post-transplant BAFF levels measured when indication biopsy was done. We checked for anti-HLA antibodies in 115 kidney transplant recipients who required allograft biopsy due to an increase in serum creatinine. With the same serum specimen, we measured BAFF levels, and in 78 of these patients, pre-transplant BAFF and anti-HLA antibody levels were detected as well. Patients in each group were divided into tertiles according to BAFF levels. We investigated the relationship between BAFF levels and the occurrence of anti-HLA antibodies. Pre-transplant BAFF levels showed significant association with pre-transplant sensitization, and also with early rejection (Tertile 3, 26.9% vs. Tertile 1, 11.5%; P<0.05). Post-transplant BAFF levels showed significant association with pre-transplant sensitization, but did not show association with anti-HLA antibodies and positive donor-specific antibodies at the time of biopsy. We did not find any association between post-transplant BAFF levels and allograft biopsy results, Banff scores and microvascular inflammation scores. In conclusion, pre-transplant BAFF levels are associated with pre-transplant sensitization and are useful in predicting allograft rejection. But post-transplant BAFF levels measured at the time of indication biopsy are not associated with the appearance of de novo HLA-DSA, allograft rejection, biopsy findings and other allograft outcomes.
Highlights
The role of B-cells in kidney transplantation, especially in acute and chronic antibody-mediated rejection (AMR) and transplantation tolerance, has been repeatedly emphasized in recent studies [1,2]
We sought to analyze the clinical significance of measuring pre-transplant and post-transplant serum BAFF levels in kidney transplant recipients We found that pre-transplant BAFF was associated with pre-sensitization and allograft rejection as in previous studies [12,13], post-transplant BAFF correlated only with pre-sensitization and not with appearance of de novo HLA-donor-specific antigens (DSA), allograft rejection, biopsy findings and other allograft outcomes
To determine the clinical significance of serum BAFF levels measured before and after transplantation, we chose to observe the correlation of BAFF levels with clinical parameters, and to divide each group of patients into tertiles according to serum BAFF levels as there has been no reference range yet that has been agreed upon, and levels vary enormously from study to study [13,16,17]
Summary
The role of B-cells in kidney transplantation, especially in acute and chronic antibody-mediated rejection (AMR) and transplantation tolerance, has been repeatedly emphasized in recent studies [1,2]. The monitoring of cytokines or chemokines associated with B cell activation or survival has been proposed as an important strategy to predict allograft outcome [1,2]. B-cell activating factor (BAFF) is a cytokine belonging to the tumor necrosis factor family that plays a role in the survival, proliferation and differentiation of B-cells [4,5]. Pre-transplant soluble BAFF levels showed correlation with the de novo appearance of donor-specific antigens (DSA) [12], while another report showed that pre-transplant BAFF levels were associated with increased AMR and decreased rejection free survival [13]. The above data strongly suggest the effects of pre-transplant BAFF levels on the outcomes of kidney transplantation (KT)
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