San Segundo D, Rodrigo E, Kislikova M, Ruiz J C, Fernandez-Fresnedo G, Asensio E, Arias M, Lopez-Hoyos M
Immunology Service, Universitary Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain.
Nephrology Service, Universitary Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain.
Transplant Proc. 2015 Jan-Feb;47(1):54-6. doi: 10.1016/j.transproceed.2014.12.011.
The response mediated by B lymphocytes has a crucial impact on kidney transplantation due to the role of anti-human leukocyte antigen antibodies in rejection and the contradictory observation of high B-lymphocyte numbers in tolerant kidney transplant recipients. The basis of the contradiction could lay in the different function of B-cell subsets depending on their degree of differentiation. We ought to measure circulating B-lymphocyte percentages in patients with end-stage renal disease before kidney transplantation to identify those with a high risk of acute rejection. Eighty patients on the waiting list for kidney transplantation followed up in our center were recruited from 2010, and samples were taken just before kidney transplantation. Eleven of 80 patients presented an episode of acute rejection (13.75%) and had an increased frequency of switched (SW) B cells compared with the rejection-free group (median [interquartile range] 24.5% [18.6% to 39.6%] vs 15.1 [8.45% to 23.4%]; P = .025). Subsequently, the frequency of SW B cells was assessed as a predicting factor of acute rejection. A value higher than 18.4% predicted patients at risk of suffering an acute rejection episode with a sensitivity of 81.8% and a specificity of 60.9% and an area under the curve of 71.2%. Moreover, a decrease in naïve B-cell subsets was related to patients at risk of acute rejection. The percentage of circulating B-cell subsets before kidney transplantation could be used as biomarker of risk to suffer acute rejection. These unicenter data must be validated in multicenter studies.
由于抗人类白细胞抗原抗体在排斥反应中的作用以及在耐受的肾移植受者中观察到的高B淋巴细胞数量这一矛盾现象，B淋巴细胞介导的反应对肾移植具有至关重要的影响。这种矛盾的基础可能在于B细胞亚群根据其分化程度具有不同的功能。我们应该在肾移植前测量终末期肾病患者循环B淋巴细胞的百分比，以识别那些有急性排斥高风险的患者。2010年起，我们中心招募了80名在肾移植等待名单上的患者，并在肾移植前采集样本。80名患者中有11名出现急性排斥发作（13.75%），与无排斥组相比，其转换型（SW）B细胞频率增加（中位数[四分位间距]24.5%[18.6%至39.6%]对15.1[8.45%至23.4%]；P = 0.025）。随后，评估SW B细胞频率作为急性排斥的预测因素。高于18.4%的值预测患者有发生急性排斥发作的风险，敏感性为81.8%，特异性为60.9%，曲线下面积为71.2%。此外，幼稚B细胞亚群的减少与急性排斥风险患者有关。肾移植前循环B细胞亚群的百分比可作为发生急性排斥风险的生物标志物。这些单中心数据必须在多中心研究中得到验证。
