The Impact Of Histological CD20 Positive B Cell Infiltration And Isolated Endarteritis In Acute Cellular Rejection On Kidney Allograft Survival

Part Ⅰ The effect of histological CD20 positive B cell infiltration in acute cellular rejection on kidney transplant allograft survivalBackgroundAcute rejection, especially the irreversible episodes, has definite impact on renal allograft. However, it is controversial whether lymphocytes infiltration exhibited in biopsy specimens is important for transplant outcomes. This study focused on the effect of CD20+B cell infiltration in the biopsy specimens from the allografts with acute cellular rejection in Chinese population.MethodsTotally 217 cases of biopsy-proved acute cellular rejection were documented in our renal transplantation system from Sep.2001 to Dec.2014. There was only 1 case lost-to-follow. According to the presence of CD20+ B cell infiltration and its degree, all 216 cases included were divided into CD20-group (n=83), mild CD20+ group (n=76), moderate CD20+ group (n=36), and severe CD20+ group (n=21). Baseline information, serum creatine and GFR before and after treatment, steroid resistance, reversal rate, graft loss and survival were analyzed.ResultsThere was no significant difference between groups in baseline information. Steroid and antibodies combination treatment in CD20+group (39.1%,52/133) and CD20- group (59.0%,49/83) didn’t show significant difference (p=0.004). CD20+ group showed better serum creatine and GFR before treatment. After treatment, however, groups showed similar graft function. CD20+group had fewer graft loss (18.8% vs.32.5%, p=0.022) and better survival rate. Further exploration in infiltration degree suggested that it was positively related with graft survival with no statistical significance.ConclusionAcute cellular rejection with CD20+ B cell infiltration showed better outcomes after treatment. The presence of CD20+ B cells is protective for renal allografts.Part II The effect of histological isolated endarteritis and solid endoarteritis combined with CD20 positive B infiltration appeared in acute cellular rejection on kidney allograft survivalBackgroundEndarteritis post renal transplantation is regarded as T-cell mediated acute rejection by Banff classification. Recently, results from DNA microarrays suggested that endovasculitis did not represent T-cell mediated acute rejection exactly and its effect on allograft outcomes was unclear.MethodsTotally 217 cases of biopsy-proved acute cellular rejection were documented in our renal transplantation system from Sep.2001 to Dec.2014. There was only 1 case lost-to-follow. After 24 cases excluded because of tubulointerstitial rejection,192 cases were included with 95 Class IA,16 Class IB,79 Class ⅡA,and 2 Class ⅡB. According to the presence of endarteritis and CD20+B cell infiltration, all 192 cases were divided into CD20-endarteritis-group (n=33), CD20+endarteritis-group (n=78),CD20-endarteritis+ group (n=46), and CD20+endarteritis+group (n=35). Baseline information, serum creatine and GFR before and after treatment, steroid resistance, reversal rate, graft loss and survival were analyzed.ResultsThere was no significant difference between groups in baseline information. Average time to rejection was separately 182 days,374 days,493 days and 729 days. The percentage of steroid and antibodies combination treatment was separately 42.8%, 63.0%,54.5% and 35.9%(p=0.022). Graft loss was separately 8.6% (3/35),23.9% (11/46),42.4%(14/33) and 23.1%(18/78) (p=0.013). Endarteritis+group showed earlier rejection (291 days vs.659 days) but higher reversal rate (77.5% (86/111) vs. 90.1%(73/81), p=0.022). GFR in endarteritis-group was significantly higher before and at rejection but signigicantly lower 3-60 months after biopsy. Endarteritis+group had a much lower graft loss rate (17.3%(14/81) vs.28.8%(32/111), p=0.064). Although general survivals were similar, survival rate after rejection in endarteritis+group was higher. The best survival was observed in CD20+ endarteritis+group.ConclusionAcute cellular rejection with endarteritis showed better outcomes after treatment. Endarteritis with CD20+B cell infiltration implies lower graft loss and better graft survival.