Pretransplant warm B cell antibodies in recipients of primary and retransplanted cadaver renal allografts.

Abstract

Eighty-four recipients of cadaveric renal allografts were retrospectively crossmatched for donor-specific pretransplant B cell antibody. Of these, 28 were found to be positive for the antibody and 56 were negative. Actuarial survival analysis over six years revealed a slightly better graft survival overall in the B-cell-negative group as compared with the B-cell-positive group (P less than 0.07). These patients were further subgrouped into those who received primary transplants and those who were retransplanted. Fifty-four percent of the B-cell-positive group (15/28) consisted of retransplants, and only 13% (7/56) of the B-cell-negative group were retransplants. When considering primary transplants only, B-cell-negative and B-cell-positive groups had similar graft survival rates (P less than 0.25). When retransplants only were considered, the graft survivals of the B-cell-positive and B-cell-negative groups were comparable (P less than 0.32). The most significant differences were observed when comparing the B-cell-positive primary transplant group with the B-cell-positive retransplanted group. The primary transplants fared consistently better at all time intervals (P less than .007). Conversely, when primary and retransplants in the B-cell-negative group were compared, no differences were noted (P less than 0.29). Our results suggest that the identification of pretransplant B-cell antibodies may be indicative of a poorer allograft survival prognosis in patients who have been previously transplanted.